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Weekend versus Weekday Procedures for Total Knee Arthroplasty.

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Weekend total knee arthroplasty (TKA) is linked to increased pain, infection, longer hospital stays, and higher costs. This study highlights a potential weekend effect impacting TKA outcomes, necessitating further investigation.

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Area of Science:

  • Orthopedic Surgery
  • Healthcare Quality and Outcomes Research
  • Health Services Research

Background:

  • Elective total knee arthroplasty (TKA) is a common procedure for managing knee osteoarthritis.
  • The impact of surgical timing, specifically weekend versus weekday procedures, on TKA outcomes is not well-established.
  • Understanding potential disparities in care based on surgical scheduling is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To compare the hospital-related outcomes of elective total knee arthroplasty (TKA) performed on weekdays versus weekends.
  • To identify potential differences in length of stay, total charges, pain, wound complications, infection rates, and mortality between weekend and weekday TKA.
  • To investigate the presence of a 'weekend effect' on TKA outcomes.

Main Methods:

  • Retrospective analysis of elective TKA cases from 2016-2020 using the Healthcare Cost and Utilization Project (HCUP) database.
  • Inclusion of 586,285 patients, with 2,199 (0.37%) undergoing weekend TKA.
  • Multivariable analysis to assess demographics, perioperative outcomes, and hospital-related outcomes including length of stay (LOS), total charges, pain, wound disruption, implant infection, and mortality.

Main Results:

  • Weekend TKA patients were slightly older and showed a predilection toward Asian, Hispanic, and Black populations.
  • Significantly increased odds of prolonged LOS (≥3 days), higher total charges, uncontrolled pain, and implant infection were observed in weekend TKA patients.
  • No significant differences were found in gender, obesity, preoperative conditions, wound disruption, or mortality between weekend and weekday TKA.

Conclusions:

  • The study indicates a significant association between weekend elective total knee arthroplasty and adverse outcomes, including increased pain, implant infection, prolonged length of stay, and higher costs.
  • These findings support the existence of a 'weekend effect' impacting TKA patient care and outcomes.
  • Further research is warranted to elucidate the underlying causes of this weekend effect and develop strategies for mitigation.