Title: Same Day Discharge in Primary Total Joint Arthroplasty in Octogenarians: A Case Series and Narrative Review of Optimization Strategies and Perioperative Outcomes

Background: The demand for total joint arthroplasty (TJA) continues to rise in an aging population, and evaluating the safety and outcomes of these procedures in octogenarians has become increasingly important. While advanced age is associated with increased medical complexity, including frailty, polypharmacy, and higher perioperative risk, growing evidence supports favorable outcomes of total joint arthroplasty in octogenarians, when patient selection and perioperative care are appropriately tailored. This study aimed to evaluate short-term perioperative outcomes among octogenarians undergoing planned same-day discharge after elective primary hip or knee arthroplasty and to contextualize these findings within optimization strategies for older surgical patients. Methods: We conducted a retrospective case series of octogenarian patients who underwent elective primary total hip, total knee, or unicompartmental knee arthroplasty at a single orthopaedic institution (2020-2023). Demographics, perioperative metrics, and 90-day outcomes were collected from the electronic health records and institutional surgical database. In parallel, a narrative review of the literature was performed to contextualize these findings within current optimization strategies for elderly arthroplasty patients. Results: Fifteen patients met the inclusion criteria, with a mean age of 81.6 years, and 5 patients were female. The mean body mass index was 25.7 ± 2.3 kg/m². Most patients were categorized as American Society of Anesthesiologists (ASA) II (n=12), with ASA III (n=2) and 1 ASA I (n=1). The median Charlson Comorbidity Index was 4. The most frequent comorbidities were hypertension (n=10), diabetes mellitus (n=3), and coronary/cardiovascular disease (n=1). Procedures included 8 total knee arthroplasties, 6 total hip arthroplasties, and 1 unicompartmental knee arthroplasty. The mean estimated blood loss was 100 ± 58 mL, and the mean operative time was 72 ± 19 minutes. All patients were discharged on the day of surgery, with a mean discharge time from the facility of approximately 4 hours. There were no intraoperative complications, no readmissions within 30 or 90 days, and no perioperative adverse events were observed. Literature review highlights the value of geriatric co-management, individualized anesthetic planning, early mobilization, and standardized discharge processes in reducing complications such as delirium, infection, and prolonged hospitalization. Conclusion: Primary same-day TJA can be safely and effectively performed in selected octogenarian patients when guided by comprehensive preoperative assessment and multidisciplinary perioperative care. This case series reinforces growing evidence that age alone should not preclude surgical intervention. Our findings contribute to an evolving understanding of evidence-based, age-inclusive arthroplasty practices.