Safety of Same-Day Total Joint Replacement: A Population-Based Cohort Study

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health

Background:

• Same-day surgery (SDS) for total joint arthroplasty (TJA) has rapidly increased, accelerated by the COVID-19 pandemic.
• Previous research often relied on single-center data, limiting generalizability.
• Population-level analysis is crucial for understanding SDS TJA trends and outcomes.

Purpose of the Study:

• To analyze the success rates of same-day TJA using population-level data from Ontario, Canada.
• To identify predictors of successful same-day discharge in elective hip and knee arthroplasty.
• To assess the safety and accessibility of SDS TJA programs.

Main Methods:

• Retrospective cohort database study utilizing linked administrative healthcare data from Ontario.
• Inclusion of all patients undergoing planned outpatient elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) from April 2016 to March 2022.
• Calculation of successful same-day TJA rates and comparison of predictors for successful discharge between patient groups.

Main Results:

• The proportion of patients selected for SDS TJA increased from 0.6% in 2016 to 23.8% in 2021.
• Overall, 11.3% (TKA) and 11.6% (THA) of planned SDS cases did not achieve same-day discharge.
• Female patients were significantly more likely to fail SDS TJA (HR: 1.14). Frailty, comorbidities (TKA), and severe obesity (THA) also predicted unsuccessful discharge.

Conclusions:

• Nearly 90% of patients planned for SDS TJA are successfully discharged on the same day.
• Female sex, frailty, and comorbidities are significant risk factors for failed SDS TJA.
• SDS TJA programs require careful evaluation to ensure safety and accessibility, particularly for female patients.