Reasons and Risk Factors for Failed Same-Day Discharge after Primary Total Knee Arthroplasty

Published:November 01, 2022DOI:

      Structured abstract


      As ambulatory total knee arthroplasty (TKA) becomes increasingly common, unplanned admission after surgery presents a challenge for the healthcare system. Studies evaluating the reasons and risk factors for this occurrence are limited. We sought to evaluate the reasons for unplanned admission after surgery and identify risk factors associated with this occurrence.


      Patients registered in an institutional ambulatory joint replacement program who underwent a TKA from 2016 to 2020 were retrospectively reviewed. Criteria for enrollment include candidates for unilateral TKA between the ages of 18 and 70 years, with a body mass index of less than 35, and appropriate social and material support at home. Patients who had certain comorbidities including coronary artery disease, valvular heart disease, and opioid dependence were not eligible. A total of 274 patients who underwent TKA with planned SDD were identified in the medical record and reviewed. In this cohort, 140 patients (51.1%) were discharged on the day of surgery and 134 patients (48.9%) required a minimum one-night admission. Demographics, comorbidities, and perioperative data were collected. Factors associated with failed SDD were identified using multivariate logistic regression.


      The most common reasons for failed SDD were failure to meet ambulation goals (25%) and logistical issues related to a late-day case (19%). Risk factors for failed SDD include general anesthesia (Odds ratio (OR) 12.60, p=0.047), procedure start time after 11:00am (OR 5.16, p<0.001), highest postoperative pain score >8 (visual analogue scale, OR 5.78, p=0.001). Willingness to accept a higher pain threshold before discharge (Visual Analogue Scale 4 to 10) was associated with successful SDD (OR 3.0, p<0.001). Age and American Society of Anesthesiologists Classification were not associated with failed SDD.


      The most common reasons for failed SDD were related to logistical issues and postoperative mobilization. Risk factors for failed SDD involve case timing and pain control. Modifiable perioperative factors may play an important role in successful same-day discharge after TKA.


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