Yoeri Bemelmans

Safety and efficacy of outpatient hip and knee arthroplasty 117 7 patient including costs for medical supplies, implants, nursing and medication et cetera), indirect costs (overhead expenses that were not directly related to patient care including administration,housekeepingetcetera), andtotalcosts[6,52].Twostudiesassessedpayment for the index hospitalization or index outpatient encounter, with a correction of payments for all post-acutecare to90-day follow-up [28, 42]. Almost all studies reportingoncostswere conducted in theUnitedStates. Sincehealthcaresystems and reimbursementmodelsdiffer between countries, these results lack external validity. This implicates that there is a need for cost-efficiencyanalysis indifferent settings toassess thepotential benefitsof outpatient joint arthroplasty internationally [5, 6, 28, 35, 41, 42, 52]. Conclusions The present systematic review and meta-analysis suggests that OJA pathways are as safe and effective as inpatient pathways following hip and knee arthroplasty in selected populations, with a potential reduction of costs. Considerable risk of bias in themajority of studies, however, emphasizes the need for large randomized controlled clinical trials comparing outpatient with inpatients pathways. Acknowledgements None. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors. Conflict of interest Author Bert Boonen is unpaid consultant for Materialise NV. The other authors declare that they have no conflict of interest. Compliance with ethical standards Authors’ contributions Yoeri Bemelmans: Conceptualization, Methodology,Writing –Original draft, Supervision Mark Keulen: Conceptualization, Methodology, Writing – Original draft, Supervision Marion Heymans: Methodology, Resource utilization, Writing – Original draft Emil van Haaren: Conceptualization, Methodology, Writing – Review & Editing Bert Boonen: Writing – Review & Editing Martijn Schotanus: Conceptualization, Methodology, Resources, Writing – Original draft, Supervision.