Reasons and Risk Factors for Failed Same-Day Discharge After Total Joint Arthroplasty
Matthew F Gong1, Mark J McElroy1, William T Li1
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
The Journal of Arthroplasty
|December 1, 2023
Summary
Same-day discharge (SDD) for total knee (TKA) and hip (THA) arthroplasty is feasible but requires careful patient selection. Key failure reasons include physical therapy issues, hypotension, and urinary retention, guiding pathway optimization.
Area of Science:
- Orthopedic Surgery
- Arthroplasty Outcomes
- Patient Recovery Pathways
Background:
- Increasing adoption of same-day discharge (SDD) for primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA).
- Need to optimize patient selection and recovery protocols for successful SDD.
- Identification of common failure causes and associated risk factors is crucial.
Purpose of the Study:
- To identify the primary reasons for failed SDD in TKA and THA patients at our institution.
- To evaluate patient-specific risk factors associated with unsuccessful SDD outcomes.
Main Methods:
- Retrospective review of patients undergoing primary TKA or THA with an SDD attempt from January 2021 to September 2022.
- Analysis of recorded reasons for SDD failure.
- Multivariate logistic regression to compare successful versus failed SDD cases.
Main Results:
- Overall SDD success rate was 85.3%.
- Failed SDD reasons included: failure to clear physical therapy (33.0%), postoperative hypotension (20.5%), and urinary retention (16.9%).
- Risk factors for failed SDD included prior opioid use, longer surgical time, and for TKA, lack of preoperative nerve block; older age was a factor for THA.
Conclusions:
- SDD pathways and selection criteria require ongoing refinement.
- Multiple factors contribute to SDD failures, necessitating improved patient selection algorithms.
- Optimizing postoperative care pathways is essential for increasing successful SDD rates.
