Design, Implementation, and Early Safety Outcomes of a Multidisciplinary Ambulatory Arthroplasty Program With Structured Home-Based Care in a Medium-Complexity Setting

Abstract

Background: Ambulatory joint arthroplasty has expanded worldwide as a safe and efficient alternative to inpatient care for selected patients. However, same-day discharge shifts postoperative risk from the hospital to the home, posing patient safety challenges-particularly in medium-complexity institutions without continuous inpatient monitoring. Many outpatient arthroplasty programs emphasize perioperative optimization but provide limited description of structured post-discharge safety strategies. Local problem: Our institution sought to expand ambulatory shoulder and knee arthroplasty while maintaining high safety standards in a secondary-level private orthopedic center. The absence of inpatient observation required a reliable system to detect and manage early postoperative complications in the home setting Methods: We designed and implemented a multidisciplinary ambulatory arthroplasty program incorporating rigorous patient selection, standardized perioperative safety protocols, and structured home-based care. Patient eligibility was assessed by orthopedics, internal medicine, anesthesiology, and infectology. Interventions included multimodal anesthesia and analgesia, infection-prevention bundles, same-day discharge criteria, in-home nursing visits, early supervised home rehabilitation, daily postoperative telephone follow-up, and scheduled outpatient assessments. This quality improvement initiative was evaluated using descriptive analysis of early safety outcomes. The primary outcome was the occurrence of major adverse events within 30 days (death, unplanned readmission, reoperation, thromboembolism, or deep surgical site infection). Results: Between February 2024 and July 2025, 41 consecutive ambulatory joint replacements (35 shoulder and 6 knee arthroplasties) were performed under the program. Adherence to perioperative and post-discharge protocols was complete. No major adverse events, readmissions, thromboembolic complications, or deep infections were observed within 30 days. Minor postoperative issues were identified early through home-based monitoring and resolved without sequelae. All patients demonstrated satisfactory functional recovery and reported high satisfaction with care. Conclusions: A deliberately designed ambulatory arthroplasty program that integrates multidisciplinary patient selection with structured home-based nursing and rehabilitation can support safe same-day discharge in medium-complexity settings. Home-based care functioned as a critical safety control after discharge and may enhance the reliability of outpatient joint replacement programs. This framework may be adaptable to other institutions seeking to expand ambulatory surgical capacity while prioritizing patient safety.