Reasons and Risk Factors for Failed Same-Day Discharge After Primary Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2023-04, Vol.38 (4), p.668-672
• Main Authors: Shen, Tony S., Rodriguez, Samuel, LeBrun, Drake G., Yu, Jonathan S., Gonzalez Della Valle, Alejandro, Ast, Michael P., Rodriguez, Jose A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; ambulatory surgery; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; early recovery; Humans; Length of Stay; Middle Aged; Pain, Postoperative - etiology; Patient Discharge; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; same-day discharge; total knee arthroplasty; total knee replacement; Young Adult
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.10.044

As ambulatory total knee arthroplasty (TKA) becomes increasingly common, unplanned admission after surgery presents a challenge for the health care system. Studies evaluating the reasons and risk factors for this occurrence are limited. We sought to evaluate the reasons for unplanned admission after surgery and identify risk factors associated with this occurrence. Patients registered in an institutional ambulatory joint arthroplasty program who underwent a TKA from 2017-2020 were retrospectively reviewed. The criteria for enrollment include candidates for unilateral TKA between the ages of 18 and 70 years, with a body mass index (BMI) of less than 35, and appropriate social and material support at home. Patients who had certain comorbidities including coronary artery disease, valvular heart disease, and opioid dependence were not eligible. A total of 274 patients who underwent TKA with planned same-day discharge (SDD) were identified in the medical record and reviewed. In this cohort, 140 patients (51.1%) were discharged on the day of surgery and 134 patients (48.9%) required a minimum 1-night admission. Demographics, comorbidities, and perioperative data were collected. Factors associated with failed SDD were identified using multivariate logistic regression. The most common reasons for failed SDD were failure to meet ambulation goals (25%) and logistical issues related to a late-day case (19%). Risk factors for failed SDD include general anesthesia (odds ratio (OR) 12.60, P = .047), procedure start time after 11:00 am (OR 5.16, P < .001), highest postoperative pain score >8 (visual analogue scale, OR 5.78, P = .001). Willingness to accept a higher pain threshold before discharge (visual analogue scale 4 to 10) was associated with successful SDD (OR 3.0, P