Reasons and Risk Factors for Failed Same-Day Discharge After Primary Total Knee Arthroplasty |
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| Affiliation: | 1. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York;2. Weill Cornell Medicine, Cornell University, New York, New York;1. Department of Orthopaedic Surgery, University of California, Irvine, School of Medicine, Orange, California;2. Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada;3. Corin Group, The Corinium Centre, Cirencester, Gloucestershire;4. Division of Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany;5. Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York;6. Melbourne Orthopaedic Group, Melbourne, Australia;1. Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota;3. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;1. Department of Orthopedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;2. Department of Orthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand;3. Department of Orthopaedics, Phramongkutklao Hospital, Bangkok, Thailand;1. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota;2. Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona;3. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota |
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| Abstract: | BackgroundAs 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.MethodsPatients 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.ResultsThe 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 < .001). Age and American Society of Anesthesiologists (ASA) classification were not associated with failed SDD.ConclusionsThe most common reasons for failed SDD were related to logistical issues and postoperative mobilization. Risk factors for failed SDD involve case timing and pain control. Modifiable perioperative factors may play an important role in successful SDD after TKA. |
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| Keywords: | total knee arthroplasty ambulatory surgery same-day discharge total knee replacement early recovery |
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