Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup

Day-case hip and knee arthroplasty can reduce bed occupancy and improve cost-effectiveness, which is crucial for addressing the increasing demand among hip and knee osteoarthritis patients. This study investigated how different arthroplasty center setups were associated with the implementation and day-of-surgery (DOS) discharge rates of a standardized day-case setup. We included unilateral primary hip and knee arthroplasty patients from seven fast-track arthroplasty centers, all implementing a standardized day-case setup in September 2022 with identical eligibility and discharge criteria. Centers were categorized as: Satellite Arthroplasty Centers (SACs): Only primary arthroplasties, separate logistics. Elective Arthroplasty Centers (EACs): Complex primaries, revisions, separate logistics. Arthroplasty Unit Orthopedic Departments (AUOs): Primary and revision procedures, integrated into a general orthopedic department. We compared DOS discharge rates from September 2022 to September 2023 with a baseline period (July 2019–December 2019) using crude percentages. We compared the DOS discharge rate for day-case-eligible patients in study period between the center types using mixed effects models. We included 6718 patients (1357 SAC, 4309 EAC, 1052 AUO) during the study period and 3974 in the baseline period. DOS discharge rates increased post-implementation across all centers (SAC: 3.9% to 30%, EAC: 5.5% to 23%, AUO: 7.4% to 14%). Compared with AUOs (36%), successful DOS discharge among eligible patients was more likely in SACs (54%; adjusted OR 3.0, 95% CI 1.3–7.1; adjusted risk difference 25 percentage points, 95% CI 5.9–44) and EACs (60%; adjusted OR 3.8, 95% CI 1.7–8.5; adjusted risk difference 31 percentage points, 95% CI 13.8–48). Arthroplasty centers with logistics separate from the general orthopedic department, SACs and EACs, were associated with higher rates of successful DOS discharge among eligible patients during implementation of a standardized day-case pathway, despite integrated arthroplasty units, AUOs, having higher day-case surgery use before implementation.