Association between same day discharge total knee and total hip arthroplasty and risks of cardiac/pulmonary complications and readmission: a population-based observational study
Jiabin Liu,1 Nabil Elkassabany,2 Jashvant Poeran,3 Alejandro Gonzalez Della Valle,4 David H Kim,1 Daniel Maalouf,1 and Stavros Memtsoudis1Hip Knee
Objective
To determine if same-day discharge total knee arthroplasty (TKA) or total hip arthroplasty (THA) is not associated with increased risk of unplanned readmission and adverse outcomes within 30 days of surgery.
Design
This is a population-based observational study.
Setting
Patients from 708 participating institutions who underwent primary TKA or primary THA between 2011 and 2017 were divided into three groups by length of stay (LOS 0, 1 and 2–3 days). All patients with LOS>3 days were excluded from the current study. Regression analysis and propensity score matching were performed.
Data sources
American College of Surgeons—National Surgical Quality Improvement Programme database.
Main outcomes and measures
Primary outcomes included unplanned readmission and cardiac/pulmonary complications within 30 days of surgery.
Results
We identified 226 481 TKA (LOS 0=3118, LOS 1=31 404, and LOS 2–3=1 91 959) and 140 557 THA patients (LOS 0=2652, LOS 1=29 617, and LOS 2–3=1 08 288). There were no differences in 30-day mortality. After adjusting for relevant covariates, LOS 0 (compared with LOS 1) was associated with higher odds of cardiac/pulmonary complications in both TKA (OR 1.95, 95% CI 1.20 to 3.16; 0.67% vs 0.37%) and THA (OR 1.96, 95% CI 1.05 to 3.64; 0.57% vs 0.26%). There were no statistical differences in unplanned readmissions between LOS 0 and LOS 1 groups in TKA (2.41% vs 2.31%) and THA (1.62% vs 2.04%).
Conclusions
LOS 0 discharge after TKA and THA was associated with higher odds of cardiac/pulmonary complications compared with LOS 1 discharge. While the overall burden of complications is relatively low, until future studies can confirm or challenge our findings, a measured approach is advisable when recommending discharge of patients on the same day of surgery.
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