Preoperative Patient-Reported Outcomes Predict Candidacy for Outpatient Total Knee Arthroplasty

The incidence of total knee arthroplasty (TKA), an effective orthopaedic procedure for end-stage osteoarthritis, is increasing substantially. The shift toward performing this procedure in the outpatient setting necessitates precise patient selection criteria to ensure optimal postoperative outcomes. This study examines the predictive value of preoperative patient-reported outcome measures (PROMs), including the Brief Resilience Scale (BRS), in determining candidacy for outpatient TKA.

A retrospective analysis of 2,167 patients undergoing elective primary, unilateral TKA from May 2020 to June 2023 was conducted. Preoperative PROMs, including Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR), Patient-Reported Outcomes Measurement Information System (PROMIS)-10, Risk Assessment and Prediction Tool (RAPT), and BRS, were collected. Patients were stratified into three groups by BRS score: low (BRS score < 3), average (BRS score ≥ 3 and < 4.3), and high (BRS score ≥ 4.3) resilience. Length of stay (LOS), discharge disposition, and complications were assessed postoperatively. Logistic regression and receiver operative characteristic (ROC) curve analyses were used to assess the predictive validity of PROMs for discharge to a skilled nursing facility (SNF) in conjunction with extended LOS.

Patients with low resilience (BRS score < 3) were found to have a significantly higher likelihood of discharge to a SNF and extended LOS compared with the other two groups (11.5% vs. 1.6%, P < 0.001). Logistic regression demonstrated that BRS, RAPT, and PROMIS-10 scores were also notable predictors, with a combined model predicting an extended LOS and discharge to SNF with 82.4% sensitivity and 79.9% specificity.

Preoperative PROMs such as BRS can serve as a valuable tool in predicting the failure of outpatient TKA. Incorporating preoperative PROMs into presurgical decision making can enhance patient selection for ambulatory procedures and improve surgical outcomes. Additional prospective studies are warranted to validate these findings within other elective surgical populations and to determine how to best modify resilience.