Outpatient Total Joint Arthroplasty at an Ambulatory Surgical Center: An Analysis of Failure to Launch

There has been a tremendous increase in same-day discharge (SDD) following primary total joint arthroplasty (TJA). Although the concept of failure to launch (FTL) has been recently investigated in hospital settings, there is a paucity of data in the ambulatory surgical center (ASC) context. This study aimed to examine the incidence and underlying causes of FTL within an ASC at a major academic medical center.

A retrospective review from 2021 to 2024 was performed on all patients who underwent same-day surgery at our ASC after intentional selection and medical optimization per institutional protocols. The demographic information, incidence and source of FTL, 90-day readmissions, and reoperations/revisions were recorded. There were 1,974 patients who underwent primary TJA at the ASC during the study.

There were nine patients who required direct hospital admission from the ASC (0.45%). This patient population had significantly increased American Society of Anesthesiologists score compared to patients who were discharged home. In addition, these patients had a significantly higher number of 90-day emergency department visits. Syncopal episodes were the most common reason for hospital admission from the ASC (66.7%), followed by nausea, seizures, and pain (all 11.1%). After review by attending orthopaedic surgeons and anesthesiologists, only two patients had potentially preventable medical causes for admission.

Approximately, 99.6% of patients had successful SDD at our ASC, underscoring the importance of proper preoperative screening. Only 0.45% of patients required hospital admission, primarily attributed to hypotension and syncopal events. Interestingly, only two patients in our cohort experienced a potentially preventable instance of FTL. It is crucial that additional efforts be aimed at identifying patients at risk and implementing treatment strategies to prevent postoperative hypotension and syncopal events that may further improve SDD and outcomes in outpatient TJA in the ASC setting.