Selecting Patients for Outpatient Surgery: A Novel Scoring System

    Which patients are appropriate candidates for outpatient joint replacement?

    That question is at the heart of the Outpatient Arthroplasty Risk Assessment (OARA) Score, which was developed by R. Michael Meneghini, MD, and his colleague at Indiana University School of Medicine in Indianapolis, Peter Caccavallo, MD, MS, a perioperative medicine specialist.

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    The OARA score was conceived as an alternative to the American Society of Anesthesiologists (ASA) score typically used to evaluate patients’ physical status before surgery. However, the ASA score lacks the sensitivity and specificity for determining which patients can safely undergo an outpatient procedure, Dr. Meneghini said in a presentation at ICJR’s Winter Hip & Knee Course.

    OARA evaluates 9 categories of health:

    • General health
    • Hematological
    • Cardiac
    • Endocrine
    • Gastrointestinal
    • Neurologic/Psychiatric
    • Renal
    • Pulmonary
    • Infectious diseases

    Each category has a point value. Patients who score a total of 60 or above are considered to be at high risk for complications; they are not good candidates for outpatient surgery. Published studies have found OARA to be more sensitive for outpatient joint surgery than the ASA score. [1-3]

    Click the image above to watch Dr. Meneghini’s presentation and hear more about outpatient joints, patient selection, and the OARA score.


    Dr. Meneghini has disclosed that he receives royalties from and is a paid consultant for DJO Global and that he has ownership shares in the IU Health Saxony Ambulatory Surgery Center.


    1. Meneghini RM, Ziemba-Davis M, Ishmael MK, Kuzma AL, Caccavallo P. Safe Selection of Outpatient Joint Arthroplasty Patients With Medical Risk Stratification: the “Outpatient Arthroplasty Risk Assessment Score.” J. Arthroplasty. 2017 Aug;32(8):2325-2331. doi: 10.1016/j.arth.2017.03.004. Epub 2017 Mar 14.
    2. Kim KY, Feng JE, Anoushiravani AA, Dranoff E, Davidovitch RI, Schwarzkopf R. Rapid Discharge in Total Hip Arthroplasty: Utility of the Outpatient Arthroplasty Risk Assessment Tool in Predicting Same-Day and Next-Day Discharge. J Arthroplasty. 2018 Aug;33(8):2412-2416. doi: 10.1016/j.arth.2018.03.025. Epub 2018 Mar 17.
    3. Ziemba-Davis M, Caccavallo P, Meneghini RM. Outpatient Joint Arthroplasty-Patient Selection: Update on the Outpatient Arthroplasty Risk Assessment Score. J Arthroplasty. 2019 Jan 15. pii: S0883-5403(19)30034-8. doi: 10.1016/j.arth.2019.01.007. [Epub ahead of print]


    More from the session Enhanced Recovery & Outpatient Arthroplasty at ICJR’s Winter Hip & Knee Course:

    Preoperative Medical Evaluation for Outpatient Total Joints, by David A. Kuppersmith MD

    Outpatient Total Joints: It’s an Evolution, by Ashley Dentler PT, DPT, CMLDT, CSCS

    An 18-Year Experience with Outpatient Joint Replacement, by Richard A. Berger MD

    Outpatient Joint Replacement Can Be a Big Mistake! by Gwo-Chin Lee MD