Early initial overnight leave after total knee arthroplasty: A novel strategy for optimizing length of stay and...

Japan's fee-for-service healthcare system leads to longer hospital stays (LOS) after total knee arthroplasty (TKA) compared to Western bundled payment models, driving up costs. Our institution implements early temporary "initial overnight leave" (IOL) to facilitate earlier home discharge and optimize resource use. This study investigates IOL's characteristics and influencing factors after primary TKA.

We conducted a retrospective cohort study of 408 osteoarthritis patients (505 knees) undergoing primary TKA between 2002 and 2024. All received standardized surgery and early full weight-bearing rehabilitation. We analyzed IOL and its correlation with patient demographics, surgical parameters, and preoperative health markers. Factors influencing IOL were examined using univariate and multivariate analyses.

The median IOL was 15 days (IQR: 10-18), with 42 % of patients achieving leave by day 10 and 79 % by day 20. Univariate analysis showed only age significantly correlated with IOL (p < 0.001, r = 0.216). Neither sex nor American Society of Anesthesiologists Physical Status influenced IOL. A weak but significant correlation existed between IOL and total LOS (p < 0.001, r = 0.300). Multivariate analysis confirmed age as a significant predictor of longer IOL (p = 0.002).

Early initial overnight leave after TKA is associated with shorter LOS and improved ADL independence, particularly in younger patients. This patient-driven practice offers a practical solution to optimize hospital resource utilization and address prolonged hospitalization challenges within Japan's healthcare system, promoting efficient and patient-centered TKA rehabilitation.