Mingyang Li1, Rong Luo1, Yi Zeng1, Yuangang Wu1, Yuan Liu1, Limin Wu1, Bin Shen2. 1. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China. 2. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, 610041, Chengdu, Sichuan, People's Republic of China. shenbin_1971@163.com.
Abstract
BACKGROUND: Published studies have reported many inconsistent results regarding the comparison of same-day discharge total joint arthroplasty (TJA) and inpatient TJA. More notably, many recent studies comparing same-day discharge TJA with fast-track TJA presented higher rates of complications for same-day discharge TJA, which raises concerns about the safety of same-day discharge TJA. METHODS: We systematically searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases up to June 2020 for studies comparing mortality, readmission, and complications in same-day discharge and inpatient total hip or knee arthroplasty. Studies that used inpatient TJA as the control could be further divided into fast-track inpatient TJA (length of stay [LOS] ≤ 2 days) and traditional inpatient TJA (no restrictions on LOS). Relative risks were pooled to compare the outcomes of the same-day discharge group and the control group. RESULTS: According to selection criteria and quality assessment, 14 studies including 222,766 cases were identified. There was no significant difference in the risk of mortality (RR = 1.42, CI [0.67, 3.01]) or readmission (RR = 0.93, CI [0.79, 1.10]) between same-day discharge TJA and inpatient TJA. Compared with fast-track TJA, the rate of overall complications in same-day discharge TJA was significantly higher (RR = 1.67, CI [1.45, 1.93]), while the rates of overall complications were similar between same-day discharge and traditional inpatient TJA (RR = 0.83, CI [0.67, 1.03]). CONCLUSION: The overall safety of same-day discharge TJA is satisfactory; however, more complications were detected in same-day discharge TJA than that in fast-track TJA. Complications in same-day discharge TJA might be underestimated in some previous studies taking long-staying inpatient TJA as control. Being more cautious about complications is necessary in the care of same-day discharge TJA, and extensive prospective studies are needed to explore the optimized option that weighs both cost and complications.
BACKGROUND: Published studies have reported many inconsistent results regarding the comparison of same-day discharge total joint arthroplasty (TJA) and inpatient TJA. More notably, many recent studies comparing same-day discharge TJA with fast-track TJA presented higher rates of complications for same-day discharge TJA, which raises concerns about the safety of same-day discharge TJA. METHODS: We systematically searched the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases up to June 2020 for studies comparing mortality, readmission, and complications in same-day discharge and inpatient total hip or knee arthroplasty. Studies that used inpatient TJA as the control could be further divided into fast-track inpatient TJA (length of stay [LOS] ≤ 2 days) and traditional inpatient TJA (no restrictions on LOS). Relative risks were pooled to compare the outcomes of the same-day discharge group and the control group. RESULTS: According to selection criteria and quality assessment, 14 studies including 222,766 cases were identified. There was no significant difference in the risk of mortality (RR = 1.42, CI [0.67, 3.01]) or readmission (RR = 0.93, CI [0.79, 1.10]) between same-day discharge TJA and inpatient TJA. Compared with fast-track TJA, the rate of overall complications in same-day discharge TJA was significantly higher (RR = 1.67, CI [1.45, 1.93]), while the rates of overall complications were similar between same-day discharge and traditional inpatient TJA (RR = 0.83, CI [0.67, 1.03]). CONCLUSION: The overall safety of same-day discharge TJA is satisfactory; however, more complications were detected in same-day discharge TJA than that in fast-track TJA. Complications in same-day discharge TJA might be underestimated in some previous studies taking long-staying inpatient TJA as control. Being more cautious about complications is necessary in the care of same-day discharge TJA, and extensive prospective studies are needed to explore the optimized option that weighs both cost and complications.
Authors: Y F L Bemelmans; M H F Keulen; M Heymans; E H van Haaren; B Boonen; M G M Schotanus Journal: Arch Orthop Trauma Surg Date: 2021-02-15 Impact factor: 2.928
Authors: Philip J Rosinsky; Sarah L Chen; Mitchell J Yelton; Ajay C Lall; David R Maldonado; Jacob Shapira; Mitchell B Meghpara; Benjamin G Domb Journal: J Orthop Surg Res Date: 2020-08-31 Impact factor: 2.359