What Do Other Studies Say?
In another study from the Journal of Arthroplasty, “Effect of Total Joint Arthroplasty Surgical Day of the Week on Length of Stay & Readmissions: A Clinical Pathway Approach,” they found no significant difference in mean length of stay (LOS) for each day of the week with the use of their clinical pathway. Readmission was also not significantly affected by surgical day of week. This study was published in December 2016.
“This is in a little bit of contrast from other studies, but our goal was to utilize 5 operating days,” he said.
He added, “Our model is unique, and I acknowledge that. We are not an ASC, so patients can easily be admitted when needed. All our surgeries are performed in hospital. We do perform unilateral knee replacements as DC same calendar day, but approximately 96% of our primary total joint arthroplasties go home within 24 hours (before 11 a.m. POD#1) and approximately 90% of our revision total joint arthroplasties go home within 24 hours as well.”
Edwards emphasized the need for accommodations to keep patients overnight, pointing to “A Multicenter Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty” published in Clinical Orthopaedics and Related Research in February 2107. In that study, 24% (27 of 122) of patients planning to have outpatient surgery were not able to be discharged the same day.
“They found that outpatient THA may be implemented without requiring additional work; however facilities to accommodate overnight stay should be available.”
Another study “Same-Day Discharge Compared with Inpatient Hospitalization Following Hip & Knee Arthroplasty” in The Journal of Bone & Joint Surgery found that while there was no difference in adverse events or readmission, inpatients had increased thromboembolic events while same-day patients had increased rate of return to the OR. In addition, patients with a body mass index of ≥35 kg/m, diabetes, and an age of ≥85 years had an increased risk of 30-day readmission following same-day procedures. It is usually due to infection, which is a common trend in the literature.
In “Who Should Not Undergo Short Stay Hip & Knee Arthroplasty? Risk Factors Associated with Major Medical Complications Following Primary Total Joint Arthroplasty”, out of 1,012 elective primary THA and TKA patients, there were 70 complications (6.9%) with 59 (84%) happening past 24 hours postop. The authors said that patients with history of COPD, CHF, CAD and cirrhosis should not be scheduled for outpatient total joint arthroplasty, another common theme in the literature.
“I think it is important that we are risk-stratifying patients, especially in an ASC where it may be more difficult to keep them in a hospital,” Edwards said pointing to another study, “Safe Selection of Outpatient Joint Arthroplasty Patients With Medical Risk Stratification: The Outpatient Arthroplasty Risk Assessment Score” published in the August 2017 Journal of Arthroplasty. This study showed that the OARA score for primary TJA has more precise predictive ability than the ASA and CCI scores for the same- or next-day discharge (81.6% vs. 56.4% and 70.3%, respectively).
Learn More about Same-Day Discharge at the Upcoming ICJR South Hip and Knee Course
Thomas L. Bradbury, M.D will discuss issues surrounding same-day discharge during the session Economics of Healthcare at the 7th Annual International Congress for Joint Reconstruction South Hip & Knee Course which will be held June 27-29, at the Ocean Reef Club in Key Largo, Florida.
The conference is designed for orthopedic surgeons and allied health professionals looking to learn the latest in orthopedic technology, surgical technique and optimum patient care. The course will include current controversies in TKA and THA, enhanced recovery and outpatient arthroplasty, and perioperative patient management.
To register, click here.
