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Same-Day Bilateral Total Knee Arthroplasty Candidacy Criteria Decrease Length of Stay and Facility Discharge.

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    Selecting appropriate candidates for simultaneous bilateral total knee arthroplasty (SBTKA) is key. Ideal candidates showed shorter hospital stays and more home discharges, indicating better outcomes for carefully chosen patients undergoing SBTKA.

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    Area of Science:

    • Orthopedic Surgery
    • Arthroplasty
    • Patient Outcomes

    Background:

    • Simultaneous bilateral total knee arthroplasty (SBTKA) may carry increased risks compared to unilateral procedures.
    • Patient selection is crucial for optimizing outcomes in SBTKA.
    • Appropriateness of Care Criteria (AOCC) can help stratify surgical risk.

    Purpose of the Study:

    • To evaluate the impact of Appropriateness of Care Criteria (AOCC) on outcomes following simultaneous bilateral total knee arthroplasty (SBTKA).
    • To identify patient subgroups who benefit most from SBTKA.
    • To inform clinical decision-making regarding patient selection for SBTKA.

    Main Methods:

    • Retrospective review of 561 patients who underwent SBTKA between 2013 and 2015.
    • Patients stratified into AOCC groups (0-4) based on age, cardiac disease, diabetes control, and BMI.
    • Analysis of length of stay, discharge disposition, and 90-day all-cause and medical complications.

    Main Results:

    • Ideal candidates (AOCC score 0) had the shortest mean length of stay (3.6 days).
    • Patients with AOCC scores >2 had significantly longer lengths of stay than those with scores ≤2 (5.2 vs 3.8 days).
    • Ideal candidates had higher home discharge rates (26% vs 13%) and a trend toward fewer medical complications.

    Conclusions:

    • AOCC scores are associated with shorter length of stay and higher home discharge rates in SBTKA patients.
    • While not statistically significant, a trend towards lower medical complications was observed in ideal candidates.
    • Appropriate patient selection for SBTKA can lead to improved outcomes, supporting its use in carefully selected individuals.