{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T08:13:37Z","timestamp":1783498417318,"version":"3.55.0"},"reference-count":32,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Total hip arthroplasty (THA) continues to shift from inpatient to outpatient facilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>We sought to examine trends in THA settings, demographic differences, and comorbidity variations to inform patient selection, outcomes, and policy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a retrospective study using data from January 1, 2019, to December 31, 2022, which we obtained from the Nationwide Inpatient Sample database and Nationwide Ambulatory Surgery Sample, from the U.S. Agency for Healthcare Research and Quality. Patients undergoing primary, elective THA were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of the 1\u2009449\u2009639 patients we identified who underwent elective THA, 843\u2009824 underwent the procedure in a hospital-owned ambulatory facility and 605\u2009815 in a hospital (inpatient setting). A total of 86% of THA volume migrated to outpatient centers from 2019 to 2022. Patients who underwent THA at an outpatient facility versus an inpatient setting were younger (65.3 vs 66.3\u2009years). A higher percentage of female versus male patients had surgery in a hospital than in an outpatient center (56.2% vs 53.8%). White and black patients were more likely to be treated at an inpatient facility, whereas Hispanic patients were more likely to be treated at an outpatient facility. Medicare and Medicaid patients were more likely to undergo surgery as inpatients. Patients with medical comorbidities, as well as smokers and patients with opioid use disorder, were overwhelmingly more likely to undergo inpatient THA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This retrospective database analysis found that from 2019 through 2022, outpatient THA numbers increased each year, with 90% of THAs being performed in hospital-owned ambulatory facilities in 2022. Patients with significant medical comorbidities and Medicare\/Medicaid insurance, as well as white and black patients, were more likely to have inpatient surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, Retrospective Database Study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15563316261431234","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T06:35:20Z","timestamp":1775543720000},"page":"378-385","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The Outpatient Surge in Total Hip Arthroplasty: National Trends in Volume Migration, Demographic Disparities, and Comorbidity Profiles (2019-2022)"],"prefix":"10.1177","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4213-8975","authenticated-orcid":false,"given":"Joseph S.","family":"Geller","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, University of Miami Miller School of Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneesh","family":"Samineni","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Miami Miller School of Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"Swonger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Miami Miller School of Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Constantinescu","sequence":"additional","affiliation":[{"name":"OrthoCarolina Hip and Knee Center, Charlotte, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3267-9356","authenticated-orcid":false,"given":"Natalia","family":"Cruz-Ossa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Miami Miller School of Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8905-1853","authenticated-orcid":false,"given":"Michele R.","family":"D\u2019Apuzzo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Miami Miller School of Medicine, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Ali M Nisar F Safri MK et al. Rate and predictors of patient satisfaction after total joint arthroplasty: a cross-sectional study in a low-to-middle-income country. Cureus. 2024;16(3):e56393. https:\/\/doi.org\/10.7759\/cureus.56393","DOI":"10.7759\/cureus.56393"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Kay A Davison B Badley E Wagstaff S. Hip arthroplasty: patient satisfaction. Br J Rheumatol. 1983;22(4):243-249. https:\/\/doi.org\/10.1093\/rheumatology\/22.4.243","DOI":"10.1093\/rheumatology\/22.4.243"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Mancuso CA Salvati EA Johanson NA Peterson MG Charlson ME. Patients\u2019 expectations and satisfaction with total hip arthroplasty. J Arthroplasty. 1997;12(4):387-396. https:\/\/doi.org\/10.1016\/s0883-5403(97)90194-7","DOI":"10.1016\/S0883-5403(97)90194-7"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Shao Z Bi S. Patient satisfaction after total hip arthroplasty: influencing factors. Front Surg. 2022;9:1043508. https:\/\/doi.org\/10.3389\/fsurg.2022.1043508","DOI":"10.3389\/fsurg.2022.1043508"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Carender CN Glass NA DeMik DE Elkins JM Brown TS Bedard NA. Projected prevalence of obesity in primary total hip arthroplasty: how big will the problem get?. J Arthroplasty. 2022;37(5):874-879. https:\/\/doi.org\/10.1016\/j.arth.2022.01.087","DOI":"10.1016\/j.arth.2022.01.087"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Patel I Nham F Zalikha AK El-Othmani MM. Epidemiology of total hip arthroplasty: demographics comorbidities and outcomes. Arthroplasty. 2023;5(1):2. https:\/\/doi.org\/10.1186\/s42836-022-00156-1","DOI":"10.1186\/s42836-022-00156-1"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Shichman I Roof M Askew N et al. Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060. JB JS Open Access. 2023;8(1):e22.00112. https:\/\/doi.org\/10.2106\/JBJS.OA.22.00112","DOI":"10.2106\/JBJS.OA.22.00112"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Turan O Emara AK et al. Outpatient total hip arthroplasty volume up nearly 8-fold after regulatory changes with expanding demographics and unchanging outcomes: a 10-year analysis. J Arthroplasty. 2024;39(8):2074-2081. https:\/\/doi.org\/10.1016\/j.arth.2024.02.048","DOI":"10.1016\/j.arth.2024.02.048"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Weiser MC Kim KY Anoushiravani AA Iorio R Davidovitch RI. Outpatient total hip arthroplasty has minimal short-term complications with the use of institutional protocols. J Arthroplasty. 2018;33(11):3502-3507. https:\/\/doi.org\/10.1016\/j.arth.2018.07.015","DOI":"10.1016\/j.arth.2018.07.015"},{"key":"e_1_3_2_11_2","doi-asserted-by":"crossref","unstructured":"Arshi A Leong NL Wang C Buser Z Wang JC SooHoo NF. Outpatient total hip arthroplasty in the United States: a population-based comparative analysis of complication rates. J Am Acad Orthop Surg. 2019;27(2):61-67. https:\/\/doi.org\/10.5435\/JAAOS-D-17-00210","DOI":"10.5435\/JAAOS-D-17-00210"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Cochrane NH Kim BI Seyler TM Wellman SS Bolognesi MP Ryan SP. The removal of total hip arthroplasty from the inpatient-only list has improved patient selection and expanded optimization efforts. J Arthroplasty. 2023;38(7S):S23-S28. https:\/\/doi.org\/10.1016\/j.arth.2023.03.007","DOI":"10.1016\/j.arth.2023.03.007"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Oeding JF Bosco JAIII Carmody M Lajam CM. RAPT scores predict inpatient versus outpatient status and readmission rates after IPO changes for total joint arthroplasty: an analysis of 12 348 cases. J Arthroplasty. 2022;37(11):2140-2148. https:\/\/doi.org\/10.1016\/j.arth.2022.05.037","DOI":"10.1016\/j.arth.2022.05.037"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"Adelani MA Keller MR Barrack RL Olsen MA. The impact of hospital volume on racial differences in complications readmissions and emergency department visits following total joint arthroplasty. J Arthroplasty. 2018;33(2):309-315.e20. https:\/\/doi.org\/10.1016\/j.arth.2017.09.034","DOI":"10.1016\/j.arth.2017.09.034"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Greenky MR Wang W Ponzio DY Courtney PM. Total hip arthroplasty and the Medicare inpatient-only list: an analysis of complications in Medicare-aged patients undergoing outpatient surgery. J Arthroplasty. 2019;34(6):1250-1254. https:\/\/doi.org\/10.1016\/j.arth.2019.02.031","DOI":"10.1016\/j.arth.2019.02.031"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"Kosykh VA Podrez EA Novikov DK et al. Effect of bezafibrate on lipoprotein secretion by cultured human hepatocytes. Atherosclerosis. 1987;68(1-2):67-76. https:\/\/doi.org\/10.1016\/0021-9150(87)90095-5","DOI":"10.1016\/0021-9150(87)90095-5"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"Leal J Wu CJ Cochrane NH et al. Outpatient versus inpatient total joint arthroplasty: do medically and socially complex patients require more resources but achieve similar outcomes?. Arthroplast Today. 2025;32:101631. https:\/\/doi.org\/10.1016\/j.artd.2025.101631","DOI":"10.1016\/j.artd.2025.101631"},{"key":"e_1_3_2_18_2","doi-asserted-by":"crossref","unstructured":"Piponov H Acquarulo B Ferreira A Myrick K Halawi MJ. Outpatient total joint arthroplasty: are we closing the racial disparities gap?. J Racial Ethn Health Disparities. 2023;10(5):2320-2326. https:\/\/doi.org\/10.1007\/s40615-022-01411-6","DOI":"10.1007\/s40615-022-01411-6"},{"key":"e_1_3_2_19_2","doi-asserted-by":"crossref","unstructured":"Taylor S Doyle M. Vested contracting to improve patient care and promote innovation within a Newfoundland and Labrador Regional Health Authority. Healthc Q. 2022;25(1):36-42. https:\/\/doi.org\/10.12927\/hcq.2022.26808","DOI":"10.12927\/hcq.2022.26808"},{"key":"e_1_3_2_20_2","doi-asserted-by":"crossref","unstructured":"Amen TB Varady NH Wright-Chisem J Bovonratwet P Parks ML Ast MP. Emerging racial disparities in outpatient utilization of total joint arthroplasty. J Arthroplasty. 2022;37(11):2116-2121. https:\/\/doi.org\/10.1016\/j.arth.2022.05.008","DOI":"10.1016\/j.arth.2022.05.008"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Barry K Mekkawy KL Nayar SK Oni JK. Racial disparities in short-stay and outpatient total hip and knee arthroplasty: 13-year trend in utilization rates and perioperative morbidity using a national database. J Am Acad Orthop Surg. 2023;31(19):e788-e797. https:\/\/doi.org\/10.5435\/JAAOS-D-22-00803","DOI":"10.5435\/JAAOS-D-22-00803"},{"key":"e_1_3_2_22_2","doi-asserted-by":"crossref","unstructured":"Connolly P Thomas J Bieganowski T et al. Outpatient vs. inpatient designation in total hip arthroplasty: can we predict who will require hospitalization?. Arch Orthop Trauma Surg. 2024;144(8):3851-3856. https:\/\/doi.org\/10.1007\/s00402-024-05502-3","DOI":"10.1007\/s00402-024-05502-3"},{"key":"e_1_3_2_23_2","doi-asserted-by":"crossref","unstructured":"Adalbert JR Constantinescu DS Orton KS D\u2019Apuzzo MR. Miscoding in the Nationwide Inpatient Sample database raises questions about validity for arthroplasty research. J Arthroplasty. 2024;39(9S2):S104-S109. https:\/\/doi.org\/10.1016\/j.arth.2024.01.022","DOI":"10.1016\/j.arth.2024.01.022"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","unstructured":"Pagan DN Hernandez VH Reddy GB D\u2019Apuzzo MR. Chronic opioid use independently increases complications and resource utilization after primary total joint arthroplasty. J Arthroplasty. 2023;38(6):1004-1009. https:\/\/doi.org\/10.1016\/j.arth.2022.12.021","DOI":"10.1016\/j.arth.2022.12.021"},{"key":"e_1_3_2_25_2","doi-asserted-by":"crossref","unstructured":"Richardson MK Wier J Liu KC et al. Same-day total joint arthroplasty in the United States from 2016 to 2020: the impact of the Medicare inpatient only list and the COVID-19 pandemic. J Arthroplasty. 2024;39(4):858-863.e2. https:\/\/doi.org\/10.1016\/j.arth.2023.10.025","DOI":"10.1016\/j.arth.2023.10.025"},{"key":"e_1_3_2_26_2","doi-asserted-by":"crossref","unstructured":"Burnett RA Barrack TN Terhune EB Della Valle CJ Shah RP Courtney PM. Over half of all Medicare total knee arthroplasty patients are now classified as an outpatient-three-year impact of the removal from the inpatient-only list. J Arthroplasty. 2023;38(6):992-997. https:\/\/doi.org\/10.1016\/j.arth.2022.12.029","DOI":"10.1016\/j.arth.2022.12.029"},{"key":"e_1_3_2_27_2","doi-asserted-by":"crossref","unstructured":"Lan RH Samuel LT Grits D Kamath AF. Contemporary outpatient arthroplasty is safe compared with inpatient surgery: a propensity score-matched analysis of 574 375 procedures. J Bone Joint Surg Am. 2021;103(7):593-600. https:\/\/doi.org\/10.2106\/JBJS.20.01307","DOI":"10.2106\/JBJS.20.01307"},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","unstructured":"Ng MK Golub IJ Piuzzi NS Razi A Wong CHJ Mont MA. Outpatient primary total hip arthroplasty is a safe alternative to inpatient primary total hip arthroplasty: a matched-cohort analysis study. Surg Technol Int. 2021;39:1490. https:\/\/doi.org\/10.52198\/21.STI.39.OS1490","DOI":"10.52198\/21.STI.39.OS1490"},{"key":"e_1_3_2_29_2","doi-asserted-by":"crossref","unstructured":"Ohmori T Fraval A Hozack WJ. Ten year experience with same day discharge outpatient total hip arthroplasty: patient demographics changed but safe outcomes were maintained. J Arthroplasty. 2024;39(9):2311-2315. https:\/\/doi.org\/10.1016\/j.arth.2024.04.050","DOI":"10.1016\/j.arth.2024.04.050"},{"key":"e_1_3_2_30_2","doi-asserted-by":"crossref","unstructured":"Yang J Olsen AS Serino J Terhune EB DeBenedetti A Della Valle CJ. Similar 90-day outcomes among inpatient and outpatient arthroplasties : a single-surgeon matched cohort analysis. Bone Joint J. 2021;103-B(7 suppl B):84-90. https:\/\/doi.org\/10.1302\/0301-620X.103B7.BJJ-2020-2341.R1","DOI":"10.1302\/0301-620X.103B7.BJJ-2020-2341.R1"},{"key":"e_1_3_2_31_2","doi-asserted-by":"crossref","unstructured":"Min BW Kim Y Cho HM et al. Perioperative pain management in total hip arthroplasty: Korean Hip Society guidelines. Hip Pelvis. 2016;28(1):15-23. https:\/\/doi.org\/10.5371\/hp.2016.28.1.15","DOI":"10.5371\/hp.2016.28.1.15"},{"key":"e_1_3_2_32_2","doi-asserted-by":"crossref","unstructured":"Osman BM Tieu TG Caceres YG Hernandez VH. Current trends and future directions for outpatient total joint arthroplasty: a review of the anesthesia choices and analgesic options. J Am Acad Orthop Surg Glob Res Rev. 2023;7(9). https:\/\/doi.org\/10.5435\/JAAOSGlobal-D-22-00259","DOI":"10.5435\/JAAOSGlobal-D-22-00259"},{"key":"e_1_3_2_33_2","doi-asserted-by":"crossref","unstructured":"Patel S Buller LT. Outpatient hip and knee arthroplasty can be safe in patients with multiple medical comorbidities via use of evidence-based perioperative protocols. HSS J. 2024;20(1):75-82. https:\/\/doi.org\/10.1177\/15563316231208431","DOI":"10.1177\/15563316231208431"}],"container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261431234","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15563316261431234","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261431234","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:17:26Z","timestamp":1783495046000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15563316261431234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/15563316261431234"],"URL":"https:\/\/doi.org\/10.1177\/15563316261431234","relation":{},"ISSN":["1556-3316","1556-3324"],"issn-type":[{"value":"1556-3316","type":"print"},{"value":"1556-3324","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]}}}