Key factors for successful 24-h discharge following Enhanced Recovery After Surgery protocols in total knee arthroplasty

Introduction: Total knee arthroplasty (TKA) remains the gold standard treatment for end-stage knee osteoarthritis. With rising TKA numbers, effective resource management, such as reducing length of stay, is crucial. While prior studies have focused on patient characteristics, this study aimed to investigate the influence of demographics and pre- and immediate postoperative patient-reported outcome measures (PROMs) on successful 24-h discharge using Enhanced Recovery After Surgery (ERAS) protocols. Methods: Patients who underwent TKA with ERAS from August 2020 to July 2021 were followed up. Successful protocol completion was defined as discharge within 24 hours of surgery. Baseline characteristics and PROMs were recorded. Outcomes measures were compared between patients who successfully completed or failed the ERAS protocol, and variables were imputed into a binary logistic regression. Results: Of 342 patients, 315 (92.1%) completed the ERAS protocol for TKA. Logistic regression analysis showed that higher postoperative pain scores and American Society of Anesthesiology (ASA) class > 2 significantly reduced the likelihood of passing the ERAS protocol (postoperative visual analogue scale odds ratio 0.742, P = 0.004; ASA > 2 odds ratio 0.196, P = 0.02). The model demonstrated satisfactory goodness of fit and accurately classified 80.1% of patients at the optimal cut-off. Receiver operating characteristic curve analysis showed good probability of discriminating between patients (area under the curve = 0.741). Conclusion: Immediate postoperative pain scores and ASA class may be useful adjuncts in predicting successful 24-h discharge after TKA using ERAS protocol.