Alex Sher1, Aakash Keswani1, Dong-Han Yao1, Michael Anderson1, Karl Koenig2, Calin S Moucha1. 1. Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York. 2. Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas, Integrated Practice Unit for Musculoskeletal Care, Austin, Texas.
Abstract
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population. METHODS: Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database. RESULTS: In total, 7474 primary TJAs among 120,847 TJA patients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population. CONCLUSION: Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA.
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJApatients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population. METHODS: Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database. RESULTS: In total, 7474 primary TJAs among 120,847 TJApatients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population. CONCLUSION:Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA.
Authors: Ran Schwarzkopf; Jerry Arraut; Mark Kurapatti; Thomas H Christensen; Joshua C Rozell; Vinay K Aggarwal; Kenneth A Egol Journal: Arch Orthop Trauma Surg Date: 2022-02-24 Impact factor: 3.067
Authors: Drake G LeBrun; Scott M LaValva; Bradford S Waddell; David J Mayman; Seth A Jerabek; Michael M Alexiades; Michael P Ast Journal: HSS J Date: 2021-11-08