While same-day discharge for joint replacement is increasingly being employed by hospitals and clinics as a way to get patients back on their feet sooner and reduce costs, the research regarding benefits and risks remains largely inconclusive.
Some research has shown that careful patient selection based on specific criteria can result in low rates of complications and need for readmission among same-day joint replacement patients while other studies suggest that sending patients home so quickly can elevate certain risks.
A recent study from Hospital for Special Surgery (HSS), “Same day discharge total joint arthroplasty is associated with increased risk of perioperative complications: a population-based study,” found that same-day discharge following total knee arthroplasty (TKA) or total hip arthroplasty (THA) was associated with a higher risk for cardiac and pulmonary complication.
The HSS researchers presented their findings at the 2019 American Society of Regional Anesthesia and Pain Medicine Annual Meeting.
Overall, there are still very few specific guidelines for these same-day joint replacements.
What’s in a Definition?
Paul K. Edwards, M.D., a hip and knee surgeon at the University of Arkansas for Medical Sciences shared some of his experiences with same-day discharge hip and knee replacement at last year’s International Congress for Joint Reconstruction (ICJR) South Hip & Knee Course at Ocean Reef.
He told attendees at the meeting that the first thing to understand about same-day discharge is that the definition can vary depending on the institution. Discharge (DC) Same Calendar Day is different from DC within 24 hours and Same Day Discharge in Hospital is different from Same Day Discharge in an ASC (ambulatory surgery center) setting. At his institution, he and his colleagues mostly perform DC within 24 hours in a hospital setting.
“Sometimes we will do DC Same Calendar Day on our unicondylars and total hips but most stay overnight and are discharged by 11 a.m. post op day 1,” he said.
He added that understanding definitional differences is important because it can get mixed up in the literature and influence how postoperative risks are assigned referring to a study, “Definitional Differences of ‘Outpatient’ versus ‘Inpatient’ THA & TKA Can Affect Study Outcomes” published in the Clinical Orthopaedics And Related Research in December 2017.
In this study, there were 72,651 total hip arthroplasties (THAs) performed and of 529 “outpatients,” only 63 (12%) had a length of stay of zero. There were also 117,454 total knee arthroplasties (TKAs) performed and of 890 “outpatients,” only 63 (11%) had a length of stay of zero.
Here “inpatient” THA was associated with increased risk of any adverse event, serious adverse event and readmission compared with “outpatient” THA. And a similar trend was also found in the TKA cohort.
