Abstract
Background
Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) are transitioning
to surgery centers, there remain limited data on trends, comorbidities, and complications
in patients discharged the same day of surgery. In addition, many studies are limited
to the Medicare population, excluding a large proportion of outpatient surgery patients.
Methods
Primary, elective THA/TKA cases between 2010 and 2017 were retrospectively identified
using the PearlDiver All-Payer Database and separated based on surgery as well as
same-day discharge (SDD) or non-SDD. Data were collected on demographics, rates, comorbidities,
and complications. Multivariable logistic regression determined adjusted odds ratios
(ORs) for 90-day complications requiring readmission for each group.
Results
In total, 1,789,601 (68.8% TKA, 31.2% THA) patients were identified where 2.9% of
TKAs and 2.2% of THAs were SDD. Annual SDD rates are increasing, with a 15.8% mean
annual change for SDD-THA and 11.1% for SDD-TKA (P < .001). SDD patients were younger with fewer comorbidities (P < .001). Regression analysis showed an overall slightly higher OR of complications
requiring readmission for SDD-TKA vs non-SDD-TKA (OR 1.14, 95% confidence interval
[CI] 1.07-1.21, P < .001). There was no significant difference for SDD-THA vs non-SDD-THA (OR 1.03,
95% CI 0.94-1.13, P = .49). In univariate analysis, SDD-THA vs SDD-TKA had more mechanical complications
(P < .001), but less pulmonary embolisms (P < .001). Regression analysis showed a slightly higher risk of complications for SDD-THA
vs SDD-TKA (OR 1.19, 95% CI 0.99-1.44, P = .05).
Conclusion
The prevalence of SDD is rising. SDD-THA is increasing more rapidly than SDD-TKA.
SDD patients are generally younger with fewer comorbidities. SDD-TKA has slightly
higher odds of complications requiring readmission than non-SDD-TKA. SDD-THA and SDD-TKA
have different complication profiles.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Outpatient total joint arthroplasty.Curr Rev Musculoskelet Med. 2017; 10: 567-574https://doi.org/10.1007/s12178-017-9451-2
- No increased risk of 90-day complication or readmission, as well as decreased cost, with total joint replacement in a private, community-based ambulatory surgery center.in: American Association of Hip and Knee Surgeons Annual Meeting. AAHKS, 2018 ([accessed 23.10.21])
- Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study.HSS J. 2014; 10: 252-255https://doi.org/10.1007/s11420-014-9401-0
- Same day total hip arthroplasty performed at an ambulatory surgical center: 90-day complication rate on 549 patients.J Arthroplasty. 2017; 32: 1103-1106https://doi.org/10.1016/j.arth.2016.10.013
- Outcomes of same-day discharge after total hip arthroplasty in the Medicare population.J Arthroplasty. 2020; 35: 638-642https://doi.org/10.1016/j.arth.2019.09.040
- Complications following outpatient total joint arthroplasty: an analysis of a national database.J Arthroplasty. 2017; 32: 1426-1430https://doi.org/10.1016/j.arth.2016.11.055
- Outpatient total knee arthroplasty is associated with higher risk of perioperative complications.J Bone Joint Surg Am. 2017; 99: 1978-1986https://doi.org/10.2106/JBJS.16.01332
- Same-day discharge following total joint arthroplasty: examining trends, discharge dispositions, and complications over time.Orthopedics. 2020; 43: 204-208https://doi.org/10.3928/01477447-20200428-03
- Variation in hospital-level risk-standardized complication rates following elective primary total hip and knee arthroplasty.J Bone Joint Surg Am. 2014; 96: 640-647https://doi.org/10.2106/JBJS.L.01639
- Hospital-level risk-standardized complication rate following elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA): measure methodology report.in: Centers for Medicare & Medicaid Services. CMS, 2012 ([accessed 09.08.21])
- The unintended impact of the removal of total knee arthroplasty from the center for Medicare and Medicaid services inpatient-only list.J Arthroplasty. 2018; 33: 3602-3606https://doi.org/10.1016/j.arth.2018.09.043
- Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: The AHRQ Elixhauser Comorbidity Index.Med Care. 2017; 55: 698-705https://doi.org/10.1097/MLR.0000000000000735
- Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.Am J Epidemiol. 2011; 173: 676-682https://doi.org/10.1093/aje/kwq433
- Defining growth potential and barriers to same day discharge total knee arthroplasty.Int Orthopaedics. 2019; 43: 1387-1393https://doi.org/10.1007/s00264-018-4100-y
- Region and insurance plan type influence discharge disposition after hip and knee arthroplasty: evidence from the privately insured US population.J Arthroplasty. 2017; 32: 3286-3291https://doi.org/10.1016/j.arth.2017.06.007
- The outpatient total hip arthroplasty: a paradigm change.Bone Joint J. 2018; 100B: 31-35https://doi.org/10.1302/0301-620X.100B1.BJJ-2017-0514.R1
- Outpatient-focused joint arthroplasty is the future: the midwest center for joint replacement experience.J Arthroplasty. 2018; 33: 1647-1648https://doi.org/10.1016/j.arth.2018.02.002
- Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications.J Arthroplasty. 2017; 32: S150-S156https://doi.org/10.1016/j.arth.2016.12.017
- Preoperative predictors of same-day discharge after total knee arthroplasty.Arthroplasty Today. 2021; 7: 182-187https://doi.org/10.1016/j.artd.2020.12.006
- Same-day discharge compared with inpatient hospitalization following hip and knee arthroplasty.J Bone Joint Surg Am. 2017; 99: 1969-1977https://doi.org/10.2106/JBJS.16.00739
- Frequency and timing of complications and catastrophic events after same-day discharge compared with inpatient total hip arthroplasty.J Arthroplasty. 2021; 36: S264-S271https://doi.org/10.1016/j.arth.2021.01.079
- Association between same day discharge total knee and total hip arthroplasty and risks of cardiac/pulmonary complications and readmission: a population-based observational study.BMJ Open. 2019; 9: 1-9https://doi.org/10.1136/bmjopen-2019-031260
Article info
Publication history
Published online: November 19, 2021
Accepted:
November 16,
2021
Received in revised form:
October 23,
2021
Received:
August 9,
2021
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2021.11.023.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
