A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Health Services Research

Background:

• Same-day discharge (SDD) total joint arthroplasty (TJA) programs typically involve strict patient selection criteria.
• However, some patients not meeting these criteria are still discharged on the same day of surgery.

Purpose of the Study:

• To compare outcomes between patients formally enrolled in an SDD TJA program and those who were discharged on the same day without formal enrollment.

Main Methods:

• A retrospective review of 1778 patients undergoing TJA between 2015 and 2020 who were discharged same-day.
• Patients were divided into two cohorts: formal SDD TJA program participants and non-participants.
• Propensity-score matching (1:1) was used to compare outcomes, including surgical time, discharge disposition, 90-day emergency department visits, readmissions, revisions, and patient-reported outcome scores.

Main Results:

• Of 1778 patients, 1384 (78%) were in the formal program and 394 (22%) were not. After matching, 550 patients were compared.
• Surgical time was significantly longer for non-participants (109.39 min) versus participants (87.29 min; P < .001).
• No significant differences were found in discharge disposition, 90-day emergency visits, 90-day readmissions, 90-day revisions, or patient-reported outcome scores (HOOS, JR and KOOS, JR) between the groups.

Conclusions:

• Formal enrollment in an SDD TJA program may not be essential for achieving comparable outcomes in same-day discharged patients.
• Institutions with robust evidence-based protocols and experience in value-based care may not require a formal SDD program.