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Same-Day Discharge Feasible for Some Higher-Risk Arthroplasty Patients

Last Updated: September 17, 2021.

FRIDAY, Sept. 17, 2021 (HealthDay News) -- At 90 days, no increase in risk for emergency department visits, unplanned readmissions, or complications is observed with same-day discharge versus inpatient stay for higher-risk patients undergoing total joint arthroplasty (TJA), according to a study published online Sept. 8 in the Journal of Bone & Joint Surgery.

Nithin C. Reddy, M.D., from Kaiser Permanente in San Diego, and colleagues compared the risk for 90-day adverse events in higher-risk patients undergoing same-day discharge versus inpatient TJA for osteoarthritis using data from the Kaiser Permanente Total Joint Replacement Registry (2017 through 2018). All included patients had an American Society of Anesthesiologists classification ≥3.

The researchers identified 5,250 patients who underwent total hip arthroplasty and 9,752 patients who underwent total knee arthroplasty, of whom 33.2 and 33.7 percent, respectively, had same-day discharge. Compared with inpatient stays, same-day discharge hip arthroplasty was noninferior in terms of emergency department visits (hazard ratio [HR], 0.73; one-sided HR 95 percent upper bound [UB], 0.84), readmissions (HR, 0.47; 95 percent UB, 0.61), and complications (HR, 0.63; 95 percent UB, 0.75). However, noninferiority was not seen for mortality (HR, 0.84; 95 percent UB, 1.97). For knee arthroplasty, same-day discharge was noninferior to an inpatient stay in terms of emergency department visits (HR, 0.79; 95 percent UB, 0.87), readmission (HR, 0.80; 95 percent UB, 0.95), complications (HR, 0.72; 95 percent UB, 0.82), and mortality (HR, 0.53; 95 percent UB, 1.03).

"We found that same-day discharge did not increase the risk of emergency department visits, unplanned readmissions, and complications as compared with an inpatient stay for higher-risk patients, suggesting that it is possible to expand indications for same-day discharge in the hospital setting while maintaining safety," Reddy said in a statement.

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