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. 2021 Jul;36(7S):S173-S178.
doi: 10.1016/j.arth.2020.12.027. Epub 2021 Jan 19.

Outcomes of a Total Joint Arthroplasty Enhanced Recovery Program in a Community Hospital Setting

Curtis T Adams  1 , Casey M O'Connor  1 , Joseph R Young  1 , Afshin A Anoushiravani  1 , Brian S Doherty  2 , Frank Congiusta  2
Affiliations

Outcomes of a Total Joint Arthroplasty Enhanced Recovery Program in a Community Hospital Setting

Curtis T Adams et al. J Arthroplasty. 2021 Jul.

Abstract

Background: Same-day discharge (SDD) total joint arthroplasty (TJA) is increasingly popular, yet there remain concerns regarding patient safety, complication rates, and unforeseen overnight admission (failure to launch; FTL). The aim of this study is to retrospectively examine the outcomes of a large consecutive SDD-TJA series in the community hospital setting.

Methods: We retrospectively reviewed 1200 consecutive SDD-TJA candidates between March 2017 and December 2019 by 5 surgeons at a community hospital. Patient demographics, perioperative data including anesthesia type, and 30-day complications were evaluated, including FTL, infection, intraoperative fracture, postoperative periprosthetic fracture or dislocation, return to operating room, and unplanned postoperative care.

Results: We included 1200 SDD patients (582/618 total hip arthroplasty/total knee arthroplasty, mean age 62.1 years, 595 females, 605 males). Spinal anesthesia was more common than general anesthesia (1087 vs 113 patients). There were 85 FTLs (7.1%), of this cohort 58.8% were female, with a mean age of 62.4 years. General anesthesia increased the risk of FTL (odds ratio 2.93). Complications resulting in FTL included block-induced neuropraxia (32.1%), orthostatic hypotension (26.1%), urinary retention (19.0%), and nausea (13.1%). Sixteen patients were readmitted within 30 days (1.3%). Six patients returned to the operating room for periprosthetic fracture (4), wound dehiscence (1), and superficial surgical site infection (1).

Conclusion: SDD-TJA can be safely performed at community hospitals, but general anesthesia should be avoided to decrease risk of FTL. Inpatient programs may allow young surgeons to gain experience with SDD-TJA while retaining overnight admission as a safety net for their patients.

Level of evidence: Level III (Prognostic).

Keywords: community hospital; failure to launch; outpatient surgery; same-day discharge; total hip and knee arthroplasty.

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