FOTO Rehab Outcomes Blog

Who are Best Candidates for Discharge 24-hours After Total Knee Arthroplasty?

Written by Selena Horner | Feb 17, 2017 11:00:00 AM

It will be imperative to individualize the time frames in care pathways. Who is a good candidate to leave the hospital within 24 hours after having a total knee replacement? 

In most cases this isn't heard of. Maybe it's because tradition has been a longer hospitalization period. I'm not even sure why a longer hospitalization was the standard. Maybe we had unsubstantiated fears?

Here's a quick view of the abstract. 

Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications.

 

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.

J Arthroplasty. 2016 Dec 22. pii: S0883-5403(16)30902-0. doi: 10.1016/j.arth.2016.12.017. [Epub ahead of print]