Physician leadership and system redesign needed to scale same-day discharge hip and knee arthroplasty

Lauwers, Bert; Hummel, Jon; Glube, Mark; Go, Fred

doi:10.1503/cmaj.74921

Cited by 1 publication

(1 citation statement)

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“…This represents an area of improvement to reduced failed discharges that can be easily implemented. 16 Effective interdisciplinary communication can be utilised to ensure all team members of the SDH pathway are aware of the contraindications to SDH surgery and flag patients who are ineligible. Perhaps the most important finding of the current study is the significant variability in failed discharge rates among treating surgeons.…”

Section: Discussionmentioning

confidence: 99%

Causes and predictors of failed same-day home discharge following primary hip and knee total joint arthroplasty: a Canadian perspective

et al. 2022

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Purpose: Same-day home (SDH) discharge in total joint arthroplasty (TJA) has increased in popularity in recent years. The objective of this study was to evaluate the causes and predictors of failed discharges in planned SDH patients. Methods: A consecutive cohort of patients who underwent total knee (TKA) or total hip arthroplasty (THA) that were scheduled for SDH discharge between 01 April 2019 and 31 March 2021 were retrospectively reviewed. Patient demographics, causes of failed discharge, perioperative variables, 30-day readmissions and 6-month reoperation rates were collected. Multivariate regression analysis was undertaken to identify independent predictors of failed discharge. Results: The cohort consisted of 527 consecutive patients. 101 (19%) patients failed SDH discharge. The leading causes were postoperative hypotension (20%) and patients who were ineligible for the SDH pathway (19%). 2 individual surgeons, later operative start time (OR 1.3; 95% CI, 1.15–1.55; p = 0.001), ASA class IV (OR 3.4; 95% CI, 1.4–8.2; p = 0.006) and undergoing a THA (OR 2.0; 95% CI, 1.2–3.1, p = 0.004) were independent predictors of failed SDH discharge. No differences in age, BMI, gender, surgical approach or type of anaesthetic were found ( p > 0.05). The 30-day readmission or 6-month reoperation were similar between groups ( p > 0.05). Conclusions: Hypotension and inappropriate patient selection were the leading causes of failed SDH discharge. Significant variability existed between individual surgeons failed discharge rates. Patients undergoing a THA, classified as ASA IV or had a later operative start time were all more likely to fail SDH discharge.

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Section: Discussionmentioning

confidence: 99%