Same-day discharge after primary total joint arthroplasty in medically screened patients: a prospective cohort study with hospital-information-system follow-up of willing and declining patients at a high-volume Asian academic center

Prospective evidence on hospital-based same-day discharge (SDD) after total joint arthroplasty (TJA) in Asian academic centers remains limited. We evaluated SDD completion and willingness to attempt SDD, with a comparison of institutionally recorded outcomes in willing and declining patients. Patients scheduled for primary unilateral total hip or knee arthroplasty after routine operative assessment by one surgeon (October 2025–April 2026) were classified by willingness to attempt SDD. No additional early SDD-specific medical exclusions occurred. Detailed caregiver and travel assessment followed willingness; declining patients received inpatient care. The primary outcome was discharge on the calendar day of surgery among willing patients. Institutional HIS outcomes were assessed at 30 days and through 29 August 2026. During revision, operation-end and discharge times were retrospectively abstracted and reconciled to describe recorded elapsed intervals. Wilson 95% confidence intervals (CIs) describe proportions; perioperative summaries include all 450 willing patients. Of 750 patients, 450 (60.0%) were willing and 300 (40.0%) declined. SDD was completed in 440/450 (97.8%; 95% CI 96.0–98.8%); the 10 non-completions were discharged the following day. The median recorded operation-end-to-discharge interval was 8.5 h (IQR 7.5–9.5) in willing patients and 21.5 h (IQR 20.0–23.1) in declining patients. All 450 willing and 300 declining patients completed the same scheduled telephone and 2- and 6-week clinic follow-up, as confirmed by the investigator. No specified HIS events were recorded in either group (0/450 and 0/300), and no additional events were reported during case-manager follow-up. All declining patients had preoperative-day admission and postoperative-day-1 discharge, spanning three calendar dates. SDD completion was high among patients who elected this supported pathway and underwent subsequent home-support assessment. The absence of institutionally recorded events does not establish comparable safety between pathways. Self-selection, the intended early-operative-scheduling policy, and incomplete characterization of home support in declining patients limit interpretation. Not applicable. This was a prospective observational cohort study of an established clinical care pathway; it was not a clinical trial and was not registered.