Key result
Current smoking (OR 6.24), maximum postoperative pain > 8 (OR 4.76), and procedure start times after 11 am (OR 2.28) significantly increased the risk of failing same-day discharge after ambulatory THA.
Why the study?
With increasing volumes of ambulatory total hip arthroplasty due to value-based care, this study aimed to identify causes and perioperative risk factors for failed same-day discharge.
What are the causes and risk factors for failed same-day discharge in patients undergoing ambulatory total hip arthroplasty?
Cohort (n=278)
No
What are the causes and risk factors for failed same-day discharge in patients undergoing ambulatory total hip arthroplasty?
Odds Ratio: 6.24 (95% CI 1.59–24.54)
p-value: p=0.009
In pre-selected patients undergoing ambulatory total hip arthroplasty, failure to clear physical therapy and patient symptomatology are the most common causes for failed same-day discharge, with smoking, high pain scores, and later surgery start times identified as significant risk factors.
Identifies factors linked to failed SDD after THA; leaves open whether interventions can raise success rates in selected patients.
Aims The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD. Methods This retrospective cohort study followed pre-selected patients for SDD THA from 1 August 2018 to 31 December 2020. Inclusion criteria were patients undergoing unilateral THA with appropriate social support, age 18 to 75 years, and BMI < 37 kg/m 2 . Patients with opioid dependence, coronary artery disease, and valvular heart disease were excluded. Demographics, comorbidities, and perioperative data were collected from the electronic medical records. Possible risk factors for failed SDD were identified using multivariate logistic regression. Results In all, 278 patients were identified with a mean age of 57.1 years (SD 8.1) and a mean BMI of 27.3 kg/m 2 (SD 4.5). A total of 96 patients failed SDD, with the most common reasons being failure to clear physical therapy (26%), dizziness (22%), and postoperative nausea and vomiting (11%). Risk factors associated with failed SDD included smokers (odds ratio (OR) 6.24; p = 0.009), a maximum postoperative pain score > 8 (OR 4.76; p = 0.004), and procedures starting after 11 am (OR 2.28; p = 0.015). A higher postoperative tolerable pain goal (numerical rating scale 4 to 10) was found to be associated with successful SDD (OR 2.7; p = 0.001). Age, BMI, surgical approach, American Society of Anesthesiologists grade, and anaesthesia type were not associated with failed SDD. Conclusion SDD is a safe and viable option for pre-selected patients interested in rapid recovery THA. The most common causes for failure to launch were failing to clear physical thereapy and patient symptomatology. Risk factors associated with failed SSD highlight the importance of preoperative counselling regarding smoking cessation and postoperative pain to set reasonable expectations. Future interventions should aim to improve patient postoperative mobilization, pain control, and decrease symptomatology. Cite this article: Bone Jt Open 2022;3(9):684–691.
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Rodriguez et al. (2022) conducted a cohort in Total hip arthroplasty (n=278). Current smoking vs. Never smoking was evaluated on Failed same-day discharge (OR 6.24, 95% CI 1.59-24.54, p=0.009). Current smoking (OR 6.24), maximum postoperative pain > 8 (OR 4.76), and procedure start times after 11 am (OR 2.28) significantly increased the risk of failing same-day discharge after ambulatory THA.
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