A new study published ahead of print in the Journal of the American Academy of Orthopaedic Surgeons forecasts U.S. total knee arthroplasty (TKA) volumes to 2040, stating that “the shift to ambulatory surgery centers has just begun.
Noting that policy changes, including removal from CMS’ Inpatient-Only (IPO) list, along with advances in surgical and perioperative care have accelerated TKA’s outpatient shift, researchers from the Departments of Orthopaedic Surgery at Maimonides Medical Center and SUNY Downstate Health Sciences University, both in Brooklyn, N.Y., conducted a retrospective analysis using data from the National Inpatient Sample and Nationwide Ambulatory Surgery Sample from 2016 to 2022.
They found that between 2016 and 2022, multi-day inpatient TKA volumes declined by 85%, while same-day discharge volumes decreased by nearly half. Conversely, they found that outpatient TKA performed in ASCs rose by more than 400% after CMS removed TKA from the IPO list. They state that Medicare's share of ASC TKA cases increased from 42.5% in 2016 to 59.2% in 2022, “reflecting a payor shift toward outpatient care.”
The researchers’ forecasting models project that by 2040, “annual ASC TKA volumes will exceed 2.1 million cases, while inpatient volumes will continue to decline substantially.”
They conclude that “TKA has undergone a dramatic shift toward outpatient delivery, with ASC procedures poised to dominate the national landscape by 2040,” and state that their findings “highlight the need for policy and infrastructure planning to support the continued growth of outpatient arthroplasty.”
