A Proposed Patient Selection Algorithm for Total Joint Arthroplasty Same-Day Discharge From an Ambulatory Surgery...

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Patient Outcomes

Background:

• Same-day discharge (SDD) for total joint arthroplasty (TJA) requires careful patient selection for safety and optimal outcomes.
• Ambulatory surgery centers (ASCs) are increasingly performing TJA, necessitating efficient discharge protocols.

Purpose of the Study:

• To investigate patient outcomes following SDD TJA at a single ASC.
• To propose an evidence-based algorithm for patient selection for SDD TJA.

Main Methods:

• Retrospective chart review of 660 patients undergoing primary TJA (total knee arthroplasty [TKA] and total hip arthroplasty [THA]) between July 2019 and October 2021.
• Data collected included successful SDD, surgery length, estimated blood loss (EBL), complications, and readmissions.

Main Results:

• Overall successful SDD rate was 99.2% (99.7% for TKA, 98.8% for THA).
• Complications occurred in 6.0% of TKAs and 4.6% of THAs.
• Body mass index, comorbidities, and EBL were associated with specific complications, but no patient characteristics were directly associated with direct hospital admission.

Conclusions:

• SDD TJA in an ASC setting demonstrated low rates of perioperative complications and hospital admissions.
• The proposed evidence-based algorithm supports the safety and feasibility of SDD TJA for carefully selected patients.