Increasing Patient Age and General Anesthesia are Risk Factors for Readmission after Same-Day Discharge in Total Hip...

As cost containment efforts in orthopaedic surgery increase, there has been a rise in same-day discharge total hip arthroplasty (THA). This has been further accelerated by the COVID-19 pandemic and the removal of THA from the Medicare inpatient-only list. This study sought to evaluate risk factors for readmission following same-day discharge THA.

From 2012-2021, the National Surgical Quality Improvement Project database was used to identify all patients undergoing elective THA discharged the day of surgery. Demographic, comorbid, and operative variables were collected. Readmission within 30 days of surgery was identified. Chi-square analysis and multivariate logistic regression was used to identify risk factors for readmission.

In total, 22,575 patients were identified undergoing same-day discharge THA. The proportion of same-day discharges increased from <1% in 2012 to 26% in 2021. 370 patients (1.6%) were readmitted within 30 days of surgery. Readmission rates were 1.5% in patients age 55-64 and 4.7% in those over 85 years (P < .001). There were lower readmission rates in those receiving neuraxial anesthesia compared to general anesthesia (1.5% vs 1.9%; P = .024). Patients with a modified frailty index score of 1 (2.0%) or 2+ (2.9%) also had increased risk of readmissions (P > .001).

Same-day discharge THA has increased rapidly in recent years. With a readmission rate of only 1.6% within 30 days of surgery, it appears to be a safe option for patients undergoing THA. Increasing patient age was the most significant risk factor for readmission following same-day surgery followed by the use of general anesthesia.