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An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence

Brook A Mitchell1, Liam M Cleary1, Linsen T Samuel1,2

  • 1Virginia Tech Carilion School of Medicine, Carilion Clinic, Roanoke, VA, USA.

Arthroplasty Today
|February 13, 2023
PubMed

Insights

The COVID-19 pandemic accelerated same-day discharge (SDD) for total joint arthroplasty (TJA) patients, increasing SDD rates significantly. This shift did not lead to more adverse events like emergency department visits or readmissions.

Area of Science:

  • Orthopedic Surgery
  • Public Health
  • Epidemiology

Background:

  • The COVID-19 pandemic significantly impacted elective procedures, including total joint arthroplasty (TJA).
  • There was a notable increase in the adoption of same-day discharge (SDD) pathways during this period.
  • This study investigates the implications of accelerated discharge following the resumption of elective TJA cases.

Purpose of the Study:

  • To assess the impact of accelerated discharge pathways on SDD rates in TJA.
  • To evaluate changes in adverse events, such as emergency department (ED) visits, readmissions, and reoperations.
  • To identify patient characteristics associated with successful SDD after total hip and total knee arthroplasty.

Main Methods:

  • A retrospective study comparing TJA patients before COVID-19 (July 2019-December 2019) and after elective surgery resumption (July 2020-December 2020).
  • Analysis of patient demographics (age, sex, BMI, ASA score) and comorbidities.
  • Comparison of length of stay, 30-day ED visits, readmissions, and reoperations between cohorts.

Main Results:

  • Same-day discharge (SDD) rates increased dramatically from 0.1% to 28.9% (P < .001).
  • Average length of stay decreased from 1.3 to 0.89 days (P < .001).
  • No significant changes were observed in 30-day ED visits, readmissions, or reoperations (P > .05).
  • Factors associated with SDD included younger age, lower BMI, male sex, and tobacco use history.

Conclusions:

  • The COVID-19 pandemic accelerated the adoption of SDD pathways for TJA at this institution.
  • This acceleration in discharge did not result in an increase in adverse events.
  • SDD pathways can be safely implemented for TJA patients, even during public health crises.
Abstract

Keywords:
Length of stayOutpatientSame day dischargeTotal hip arthroplasty (THA)Total knee arthroplasty (TKA)

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