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Observational Study
. 2019 Dec 8;9(12):e031260.
doi: 10.1136/bmjopen-2019-031260.

Association between same day discharge total knee and total hip arthroplasty and risks of cardiac/pulmonary complications and readmission: a population-based observational study

Jiabin Liu  1 , Nabil Elkassabany  2 , Jashvant Poeran  3 , Alejandro Gonzalez Della Valle  4 , David H Kim  5 , Daniel Maalouf  5 , Stavros Memtsoudis  5
Affiliations
Observational Study

Association between same day discharge total knee and total hip arthroplasty and risks of cardiac/pulmonary complications and readmission: a population-based observational study

Jiabin Liu et al. BMJ Open. .

Abstract

Objective: To determine if same-day discharge total knee arthroplasty (TKA) or total hip arthroplasty (THA) is not associated with increased risk of unplanned readmission and adverse outcomes within 30 days of surgery.

Design: This is a population-based observational study.

Setting: Patients from 708 participating institutions who underwent primary TKA or primary THA between 2011 and 2017 were divided into three groups by length of stay (LOS 0, 1 and 2-3 days). All patients with LOS>3 days were excluded from the current study. Regression analysis and propensity score matching were performed.

Data sources: American College of Surgeons-National Surgical Quality Improvement Programme database.

Main outcomes and measures: Primary outcomes included unplanned readmission and cardiac/pulmonary complications within 30 days of surgery.

Results: We identified 226 481 TKA (LOS 0=3118, LOS 1=31 404, and LOS 2-3=1 91 959) and 140 557 THA patients (LOS 0=2652, LOS 1=29 617, and LOS 2-3=1 08 288). There were no differences in 30-day mortality. After adjusting for relevant covariates, LOS 0 (compared with LOS 1) was associated with higher odds of cardiac/pulmonary complications in both TKA (OR 1.95, 95% CI 1.20 to 3.16; 0.67% vs 0.37%) and THA (OR 1.96, 95% CI 1.05 to 3.64; 0.57% vs 0.26%). There were no statistical differences in unplanned readmissions between LOS 0 and LOS 1 groups in TKA (2.41% vs 2.31%) and THA (1.62% vs 2.04%).

Conclusions: LOS 0 discharge after TKA and THA was associated with higher odds of cardiac/pulmonary complications compared with LOS 1 discharge. While the overall burden of complications is relatively low, until future studies can confirm or challenge our findings, a measured approach is advisable when recommending discharge of patients on the same day of surgery.

Keywords: health & safety; hip; knee; orthopaedic & trauma surgery.

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Conflict of interest statement

Competing interests: None declared.

References

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