Skip to main content

Advertisement

SpringerLink
Log in

Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

As more centers introduce same-day discharge (SDD) total joint arthroplasty (TJA) programs, it is vital to understand the factors associated with successful outpatient TJA and whether outcomes vary for those that failed SDD. The purpose of this study is to compare outcomes of patients that are successfully discharged home the day of surgery to those that fail-to-launch (FTL) and require a longer in-hospital stay.

Materials and methods

We retrospectively reviewed all patients who enrolled in our institution’s SDD TJA program from 2015 to 2020. Patients were stratified into two cohorts based on whether they were successfully SDD or FTL. Outcomes of interest included discharge disposition, 90-day readmissions, 90-day revisions, surgical time, and patient-reported outcome measures (PROMs) as assessed by the FJS-12 (3 months, 1 year, and 2 years), HOOS, JR, and KOOS, JR (preoperatively, 3 months, and 1 year). Demographic differences were assessed with chi-square and Mann–Whitney U tests. Outcomes were compared using multilinear regressions, controlling for demographic differences.

Results

A total of 1491 patients were included. Of these, 1384 (93%) were successfully SDD while 107 (7%) FTL and required a longer length-of-stay. Patients who FTL were more likely to be non-married (p = 0.007) and ASA class III (p = 0.017) compared to those who were successfully SDD. Surgical time was significantly longer for those who FTL compared to those who were successfully SDD (100.86 vs. 83.42 min; p < 0.001). Discharge disposition (p = 0.100), 90-day readmissions (p = 0.897), 90-day revisions (p = 0.997), and all PROM scores both preoperatively and postoperatively did not significantly differ between the two cohorts.

Conclusion

Our results support the notion that FTL is not a predictor of adverse outcomes as patients who FTL achieved similar outcomes as those who were successfully SDD. The findings of this study can aid orthopedic surgeons to educate their patients who wish to participate in a similar program, as well as patients that have concerns after they failed to go home on the day of surgery.

Level III Evidence

Retrospective Cohort Study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pivec R, Johnson AJ, Mears SC, Mont MA (2012) Hip arthroplasty. In: The Lancet

  2. Function M, Performance M, Arthroplasty WJ (2008) Standard of care: total knee arthroplasty standard of care : total knee arthroplasty. Brigham woman’s Hosp

  3. Ethgen O, Bruyerè O, Richy F et al (2004) Health-related quality of life in total hip and total knee arthroplasty: a qualitative and systematic review of the literature. J Bone Jt Surg - Ser A 86:963–974

    Article  Google Scholar 

  4. Canovas F, Dagneaux L (2018) Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res

  5. Kremers HM, Larson DR, Crowson CS et al (2014) Prevalence of total hip and knee replacement in the United States. J Bone Jt Surg - Am 97:1386–1397. https://doi.org/10.2106/JBJS.N.01141

    Article  Google Scholar 

  6. Burn E, Edwards CJ, Murray DW et al (2018) Trends and determinants of length of stay and hospital reimbursement following knee and hip replacement: Evidence from linked primary care and NHS hospital records from 1997 to 2014. BMJ Open. https://doi.org/10.1136/bmjopen-2017-019146

    Article  PubMed  PubMed Central  Google Scholar 

  7. Weiser MC, Kim KY, Anoushiravani AA et al (2018) Outpatient total hip arthroplasty has minimal short-term complications with the use of institutional protocols. J Arthroplasty 33:3502–3507. https://doi.org/10.1016/j.arth.2018.07.015

    Article  PubMed  Google Scholar 

  8. Hoffmann JD, Kusnezov NA, Dunn JC, et al (2018) The shift to same-day outpatient joint arthroplasty: a systematic review. J. Arthroplasty

  9. Sher A, Keswani A, Yao D et al (2017) Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications. J Arthroplasty. https://doi.org/10.1016/j.arth.2016.12.017

    Article  PubMed  Google Scholar 

  10. Berger RA, Sanders SA, Thill ES, et al (2009) Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. In: Clin Orthopaed Relat Res

  11. Khan SK, Malviya A, Muller SD et al (2014) Reduced short-term complications and mortality following enhanced recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop. https://doi.org/10.3109/17453674.2013.874925

    Article  PubMed  PubMed Central  Google Scholar 

  12. Padilla JA, Gabor JA, Schwarzkopf R, Davidovitch RI (2019) A novel opioid-sparing pain management protocol following total hip arthroplasty: effects on opioid consumption, pain severity, and patient-reported outcomes. J Arthroplasty 34:2669–2675. https://doi.org/10.1016/j.arth.2019.06.038

    Article  PubMed  Google Scholar 

  13. Gillis ME, Dobransky J, Dervin GF (2019) Defining growth potential and barriers to same day discharge total knee arthroplasty. Int Orthop 43:1387–1393. https://doi.org/10.1007/s00264-018-4100-y

    Article  PubMed  Google Scholar 

  14. Stambough JB, Nunley RM, Curry MC et al (2015) Rapid recovery protocols for primary total hip arthroplasty can safely reduce length of stay without increasing readmissions. J Arthroplasty. https://doi.org/10.1016/j.arth.2015.01.023

    Article  PubMed  PubMed Central  Google Scholar 

  15. Berend KR, Lombardi AV, Mallory TH (2004) Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int

  16. Kehlet H, Wilmore DW (2008) Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. https://doi.org/10.1097/SLA.0b013e31817f2c1a

    Article  PubMed  Google Scholar 

  17. Lovecchio F, Alvi H, Sahota S et al (2016) Is outpatient arthroplasty as safe as fast-track inpatient arthroplasty? a propensity score matched analysis. J Arthroplasty 31:197–201. https://doi.org/10.1016/j.arth.2016.05.037

    Article  PubMed  Google Scholar 

  18. Springer BD, Odum SM, Vegari DN et al (2017) Impact of inpatient versus outpatient total joint arthroplasty on 30-day hospital readmission rates and unplanned episodes of care. Orthop Clin North Am 48:15–23

    Article  Google Scholar 

  19. Otero JE, Gholson JJ, Pugely AJ et al (2016) Length of hospitalization after joint arthroplasty: does early discharge affect complications and readmission rates? J Arthroplasty 31:2714–2725. https://doi.org/10.1016/j.arth.2016.07.026

    Article  PubMed  Google Scholar 

  20. Kort NP, Bemelmans YFL, van der Kuy PHM, et al (2017) Patient selection criteria for outpatient joint arthroplasty. Knee Surg Sport Traumatol Arthrosc

  21. Meneghini RM, Ziemba-Davis M, Ishmael MK et al (2017) Safe selection of outpatient joint arthroplasty patients with medical risk stratification: the “outpatient arthroplasty risk assessment score.” J Arthroplasty 32:2325–2331. https://doi.org/10.1016/j.arth.2017.03.004

    Article  PubMed  Google Scholar 

  22. Kim KY, Feng JE, Anoushiravani AA et al (2018) Rapid discharge in total hip arthroplasty: utility of the outpatient arthroplasty risk assessment tool in predicting same-day and next-day discharge. J Arthroplasty 33:2412–2416. https://doi.org/10.1016/j.arth.2018.03.025

    Article  PubMed  Google Scholar 

  23. Goyal N, Chen AF, Padgett SE et al (2017) Otto aufranc award: a multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clin Orthop Relat Res 475:364–372. https://doi.org/10.1007/s11999-016-4915-z

    Article  PubMed  Google Scholar 

  24. Gromov K, Kjærsgaard-Andersen P, Revald P et al (2017) Feasibility of outpatient total hip and knee arthroplasty in unselected patients: A prospective 2-center study. Acta Orthop. https://doi.org/10.1080/17453674.2017.1314158

    Article  PubMed  PubMed Central  Google Scholar 

  25. Coenders MJ, Mathijssen NMC, Vehmeijer SBW (2020) Three and a half years’ experience with outpatient total hip arthroplasty. Bone Jt J. https://doi.org/10.1302/0301-620X.102B1.BJJ-2019-0045.R2

    Article  Google Scholar 

  26. Fraser JF, Danoff JR, Manrique J et al (2018) Identifying reasons for failed same-day discharge following primary total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2018.08.003

    Article  PubMed  Google Scholar 

  27. Gogineni HC, Gray CF, Prieto HA et al (2019) Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center. Arthroplast Today 5:100–105. https://doi.org/10.1016/j.artd.2018.10.008

    Article  PubMed  Google Scholar 

  28. Keulen MHF, Asselberghs S, Bemelmans YFL et al (2020) Reasons for unsuccessful same-day discharge following outpatient hip and knee arthroplasty: 5½ years’ experience from a single institution. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.04.064

    Article  PubMed  Google Scholar 

  29. Keulen MHF, Asselberghs S, Boonen B et al (2020) Predictors of (un)successful same-day discharge in selected patients following outpatient hip and knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2020.03.034

    Article  PubMed  Google Scholar 

  30. Lieberman EG, Hansen EJ, Clohisy JC et al (2021) Allergies, preoperative narcotic use, and increased age predict failed same day discharge after joint replacement. J Arthroplasty. https://doi.org/10.1016/j.arth.2021.01.015

    Article  PubMed  Google Scholar 

  31. Giesinger JM, Kuster MS, Holzner B, Giesinger K (2013) Development of a computer-adaptive version of the forgotten joint score. J Arthroplasty 28:418–422. https://doi.org/10.1016/j.arth.2012.08.026

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lyman S, Lee YY, Franklin PD et al (2016) Validation of the HOOS, JR: a short-form hip replacement survey. Clin Orthop Relat Res 474:1472–1482. https://doi.org/10.1007/s11999-016-4718-2

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lyman S, Lee YY, Franklin PD et al (2016) Validation of the KOOS, JR: a short-form knee arthroplasty outcomes survey. Clin Orthop Relat Res 474:1461–1471. https://doi.org/10.1007/s11999-016-4719-1

    Article  PubMed  PubMed Central  Google Scholar 

  34. Aynardi M, Post Z, Ong A et al (2014) Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J 10:252–255. https://doi.org/10.1007/s11420-014-9401-0

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kim KY, Anoushiravani AA, Elbuluk A et al (2018) Primary total hip arthroplasty with same-day discharge: Who failed and why. Orthopedics. https://doi.org/10.3928/01477447-20171127-01

    Article  PubMed  Google Scholar 

  36. Hartog YMD, Mathijssen NMC, Vehmeijer SBW (2013) Reduced length of hospital stay after the introduction of a rapid recovery protocol for primary THA procedures. Acta Orthop. https://doi.org/10.3109/17453674.2013.838657

    Article  PubMed  Google Scholar 

  37. Larsen JR, Skovgaard B, Prynø T et al (2017) Feasibility of day-case total hip arthroplasty: A single-centre observational study. HIP Int. https://doi.org/10.5301/hipint.5000421

    Article  PubMed  Google Scholar 

  38. Parcells BW, Giacobbe D, MacKnet D et al (2016) Total joint arthroplasty in a stand-alone ambulatory surgical center: Short-term outcomes. Orthopedics. https://doi.org/10.3928/01477447-20160419-06

    Article  PubMed  Google Scholar 

  39. Gabor JA, Singh V, Schwarzkopf R, Davidovitch RI (2020) Similar outcomes after hospital-based same-day discharge vs inpatient total hip arthroplasty. Arthroplast Today 6:451–456. https://doi.org/10.1016/j.artd.2020.05.008

    Article  PubMed  PubMed Central  Google Scholar 

  40. Berger RA, Kusuma SK, Sanders SA, et al (2009) The feasibility and perioperative complications of outpatient knee arthroplasty. In: Clin Orthopaed Relat Res

  41. Sibia US, King PJ, MacDonald JH (2017) Who is not a candidate for a 1-day hospital-based total knee arthroplasty? J Arthroplasty. https://doi.org/10.1016/j.arth.2016.06.055

    Article  PubMed  Google Scholar 

  42. Husted H, Holm G, Jacobsen S (2008) Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthop. https://doi.org/10.1080/17453670710014941

    Article  PubMed  Google Scholar 

  43. Sibia US, MacDonald JH, King PJ (2016) Predictors of hospital length of stay in an enhanced recovery after surgery program for primary total hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2016.02.060

    Article  PubMed  Google Scholar 

  44. Ali A, Lindstrand A, Sundberg M, Flivik G (2017) Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up. J Arthroplasty 32:767–770. https://doi.org/10.1016/j.arth.2016.08.033

    Article  PubMed  Google Scholar 

  45. Lopez-Olivo MA, Landon GC, Siff SJ et al (2011) Psychosocial determinants of outcomes in knee replacement. Ann Rheum Dis 70:1775–1781. https://doi.org/10.1136/ard.2010.146423

    Article  PubMed  Google Scholar 

  46. Horn EE, Xu Y, Beam CR et al (2013) Accounting for the physical and mental health benefits of entry into marriage: A genetically informed study of selection and causation. J Fam Psychol 27:30–41. https://doi.org/10.1037/a0029803

    Article  PubMed  Google Scholar 

  47. Carr D, Springer KW (2010) Advances in families and health research in the 21st century. J Marriage Fam 72:743–761. https://doi.org/10.1111/j.1741-3737.2010.00728.x

    Article  Google Scholar 

  48. Robards J, Evandrou M, Falkingham J, Vlachantoni A (2012) Marital status, health and mortality. Maturitas 73:295–299. https://doi.org/10.1016/j.maturitas.2012.08.007

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lall AC, Schwarzman GR, Battaglia MR et al (2019) Effect of marital status on patient-reported outcomes following total hip arthroplasty: a matched analysis with minimum 2-year follow-up. HIP Int. https://doi.org/10.1177/1120700019864015

    Article  PubMed  Google Scholar 

  50. Belmont PJ, Goodman GP, Waterman BR, et al (2014) Thirty-day postoperative complications and mortality following total knee arthroplasty: Incidence and risk factors among a national sample of 15,321 patients. J Bone Jt Surg Ser A

  51. Mathijssen NMC, Verburg H, van Leeuwen CCG et al (2016) Factors influencing length of hospital stay after primary total knee arthroplasty in a fast-track setting. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-015-3932-x

    Article  Google Scholar 

  52. Inneh IA (2015) The combined influence of sociodemographic, preoperative comorbid and intraoperative factors on longer length of stay after elective primary total knee arthroplasty. J Arthroplasty. https://doi.org/10.1016/j.arth.2015.05.032

    Article  PubMed  Google Scholar 

  53. Garbarino LJ, Gold PA, Sodhi N et al (2019) The effect of operative time on in-hospital length of stay in revision total knee arthroplasty. Ann Transl Med 7:66–66. https://doi.org/10.21037/atm.2019.01.54

  54. Jans B-N, Solgaard S et al (2012) Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. Br J Anaesth. https://doi.org/10.1093/bja/aer403

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Langone Health, The New York Hip Institute, 485 Madison Ave. 8th Floor, New York, USA

    Vivek Singh MD, MPH , Afamefuna M. Nduaguba MD , William Macaulay MD , Ran Schwarzkopf MD, MSc  & Roy I. Davidovitch MD

Authors
  1. Vivek Singh MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Afamefuna M. Nduaguba MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William Macaulay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ran Schwarzkopf MD, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roy I. Davidovitch MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roy I. Davidovitch MD .

Ethics declarations

Conflict of interest

V.S and A.M.N have nothing to disclose. W.M holds stock options in OrthoAlign. R.S is a paid consultant for Intellijoint and Smith & Nephew and holds stock options in Gauss Surgical. R.D is a paid consultant for Radlink, Schaerer Medical, Exactech, and Medtronics. The authors declare that they have no conflict of interest pertinent to this study.

Ethical approval

The present study was exempt from human-subjects review by our institutional review board (IRB).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Singh, V., Nduaguba, A.M., Macaulay, W. et al. Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes. Arch Orthop Trauma Surg 142, 861–869 (2022). https://doi.org/10.1007/s00402-021-03983-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-03983-0

Keywords

Search

Navigation