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

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.

SUBMITTER: Liu J 

PROVIDER: S-EPMC6924781 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature