Day-case knee and hip replacement

Area of Science:

• Orthopedic Surgery
• Health Services Research

Background:

• Day-case knee and hip replacement, where patients go home the same day, has grown in popularity, especially since the COVID-19 pandemic.
• This surgical approach aims to improve efficiency and patient experience.

Purpose of the Study:

• To systematically review and compare the evidence for day-case versus inpatient-stay knee and hip replacement surgery.
• To evaluate outcomes such as readmission, complications, reoperation, mortality, and patient-reported measures.

Main Methods:

• A systematic literature search was conducted across MEDLINE, Embase, and grey literature databases.
• Meta-analyses were performed using a random effects model for comparable studies.
• The review included 38 studies involving 83,888 day-case procedures.

Main Results:

• Day-case patients were younger, more likely male, and had lower BMI and ASA grades.
• Day-case surgery showed significantly lower odds of readmission, emergency department attendance, and complications.
• No significant differences were found in reoperation or mortality rates; 85% of day-case patients had successful same-day discharge.

Conclusions:

• Day-case knee and hip replacement outcomes appear non-inferior to inpatient stays, despite potential selection bias in current literature.
• Evidence is stronger for unicompartmental knee replacement (UKR) compared to total knee replacement (TKR) and total hip replacement (THR).
• Successful same-day discharge rates were highest for UKR, followed by TKR and THR.