Same Day Arthroplasty in the Community Setting: An Institutional Experience Examining Factors for Successful Discharge

Background Outpatient total joint arthroplasty has been at the forefront of orthopedic surgery. While there have been many publications regarding outpatient total joint arthroplasty in large academic settings, large-volume studies examining outcomes in community settings are lacking. This investigation reports a community institution’s experience in implementing same-day total hip arthroplasty (THA), total knee arthroplasty (TKA) and factors influencing failure to complete same-day discharge. Methods A retrospective chart review of patients scheduled for same-day THA and TKA across 7 community hospitals within a single institution from December 2021 to September 2023 was performed. Patients were given the same-day discharge designation based on a pre-established institutional protocol. The primary outcome was the successful completion of the same-day discharge. Secondary outcomes included factors associated with failure to discharge on the day of surgery. Multivariate regression analysis was used to investigate several of these factors. Results 688 patients were included of which 434 underwent TKA, 254 underwent THA. 113 in the TKA group and 70 in the THA group failed to discharge on the same calendar day and were admitted for an overnight stay. Overall, poor ambulation (< 105ft) with physical therapy in the post-operative unit was the most important determinate of failed discharge (OR 5.61, 95% CI 3.63-8.65, p=<.0001). In TKA, patients who received peripheral nerve blocks were significantly more likely to successfully discharge (OR 0.49, 95% CI 0.27-0.88, p=0.0170). Conclusions At this institution, peripheral nerve blocks resulted in higher successful discharges. The single most important factor regarding successful discharge at this institution, also demonstrated by many others, seemed to be ambulation in the post-operative unit, which is in congruity with a pre-established institutional protocol of 75 feet of minimal ambulation distance. Therefore, perioperative decision making should focus on factors that will enable patients to be most successful with physical therapy.