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

Sher, Alex; Keswani, Aakash; Yao, Dorcas C.; Anderson, Mike B.; Koenig, Karl; Moucha, Calin S.

doi:10.1016/j.arth.2016.12.017

Cited by 99 publications

(127 citation statements)

References 30 publications

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“…Sher and colleagues show a higher prevalence of impaired functional status, history of pulmonary and cardiac disease, stroke, and ASA class ≥ 3 among patients who were not eligible for same-day discharge following total knee or hip arthroplasty [12]. Similarly, Basques and colleagues report that diabetes mellitus and older age were shown to be associated with higher rates of 30-day readmission following same-day discharger for joint arthroplasty [17].…”

Section: Discussionmentioning

confidence: 98%

“…In 2017, United States health care spending grew by 3.9% and comprises roughly 18% of annual spending [11]. Same-day discharge has been identified as a potential opportunity to lower costs while improving patient satisfaction and quality of care for joint arthroplasty [12]. The recent demand for ambulatory surgery may be due to escalating health care costs, and implementing same-day surgery This article is protected by copyright of Korean Journal of Anesthesiology.…”

Section: Discussionmentioning

confidence: 99%

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Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Burton

Finneran

Angerstein

et al. 2021

Korean J Anesthesiol

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Background: We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients. Methods: Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these two outcomes. The odds ratio (OR) and 95% confidence interval (CI) were reported for each covariate that remained in the final models. Results: There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure, bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, congestive heart failure, bleeding disorder, and higher comorbidity burden (all P < 0.001). Conclusions: The results of this study that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Burton

Finneran

Angerstein

et al. 2021

Korean J Anesthesiol

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“…In some reports a length of stay of <23 hours is defined as outpatient (Sher et al. 2017 ), whereas others define outpatient as hospital discharge on the day of surgery (Nelson et al. 2017 ).…”

Section: Definition Of Outpatient Tha and Tkamentioning

confidence: 99%

Outpatient total hip and knee arthroplasty

2017

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As a result of the introduction of fast-track programs, the length of hospital stay after arthroplasty has decreased to a point where some patients meet the discharge criteria on the day of surgery. In several studies, well-established fast-track centers have demonstrated the feasibility of outpatient procedures in selected patients. However, in literature the term “outpatient” is sometimes also used for patients who spend one or more nights in hospital. We therefore propose to use “outpatient” solely for patients who are discharged to their own home on the day of surgery and do not have an overnight stay at either the hospital or another non-home facility. Also, several challenges need to be overcome before this becomes an established procedure. The combination of preoperative high-dose steroids and multimodal opioid-sparing analgesia has enhanced patient recovery after arthroplasty, but efforts to control undesirable pathophysiological responses will be a prerequisite to improve the success rate of an outpatient setting. Also, care must be taken to avoid extra activities or investments solely to enable discharge on the day of surgery. Further cost analyses will have to be performed to establish the true financial benefit of outpatient treatment.

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“…Thus, our projections may have been underestimated. 19,33 Due to data limitations, we were unable to directly track patients across time or to obtain revision rates; thus, we estimated a revision rate from Medicare claims data for all procedures, regardless of payer. 22 Also, data regarding SSIs resulting from a revision arthroplasty can also be difficult to obtain.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown no significant difference between adverse events following outpatient vs. inpatient surgery, however outpatient surgical patients tend to have fewer risk factors for surgical complications. 19,20 …”

Section: Methodsmentioning

confidence: 99%

The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030

Wolford

Hatfield

Paul

et al. 2018

Infect. Control Hosp. Epidemiol.

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

Cited by 99 publications

References 30 publications

Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Outpatient total hip and knee arthroplasty

The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030

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