Role of Perioperative Fluid Resuscitation in Same-Day Total Joint Arthroplasty Discharge at a Level 1 Academic Center

Elderly patients are often dehydrated and are at risk of having prolonged recovery from surgery because of comorbidities and anesthesia. The aim of this study was to investigate the effects of perioperative fluid management on same-day discharge (SDS) rates, physical therapy performance, and complications in elective total joint arthroplasty (TJA).

A retrospective review of 158 patients with primary TJA performed as first-start cases was conducted, consisting of 77 total knee and 81 total hip arthroplasty patients from 2021 to 2023. Intraoperative fluids and total perioperative fluids given on the date of surgery were compared between SDS and admitted patients.

Of the 158 TJA first-start cases, 13% of patients were discharged home on postoperative day 0, including 10% of TKA patients and 21% of THA patients. SDS patients were found to have a markedly higher total fluids/body mass index (BMI) ratio and mean intraoperative fluid administration by 400 mL compared with non-SDS patients. Patients who were hypotensive during therapy had a lower total fluids/BMI ratio.

The total fluids/BMI ratio may be a useful tool to help guide appropriate intraoperative fluid administration based on varying BMI ranges. Intraoperative fluids during surgical intervention may be more beneficial in postoperative recovery compared with relying on oral replenishment.