Growing Popularity of Same-Day Discharge

The number of TJA cases—which encompasses total knee arthroplasties (TKA) and total hip arthroplasties (THA)—is growing. The total number of TKA and THA cases is estimated to surpass 1.5 million by 2030. In fact, according to the American Academy of Orthopedic Surgeons, the TJA caseload needs to be doubled to meet demand by 2050. While many studies reported successful outcomes of SDD, patient perception of SDD is poorly reported. As an orthopedic surgeon specializing in hip and knee joint replacement surgeries, Park strived to better understand the patients’ perceptions and preferences of post-operative care. Park and his team surveyed 67 patients who experienced both SDD and ONS. This unique cohort of patients had undergone TKA or THA in both settings.

“Same-day discharge after total joint arthroplasty is on the rise in the United States for numerous reasons, and proper selection of patients and improvements in perioperative multidisciplinary care coordination have allowed for this transition. More recently, the rise has further been aided by the COVID-19 pandemic. Many studies have reported that same-day discharge is safe in properly selected patients, with a complication rate that is similar to that of overnight stay,” said Park.

Park and his team retrospectively identified 67 patients who each underwent either two TKAs or two THAs in both SDD and ONS settings at Houston Methodist. Patients selected were non-smokers, 74 years or younger with: a body mass index of 33 or below, less or equal to two stable chronic conditions and access to a caregiver for three days post-surgery. The first surgery was followed by an ONS, and the second surgery entailed SDD in each case. Notably, each patient experienced SDD after ONS. SDD surgeries were performed between October 2019 and August 2021, and the same surgeon (one out of eight) performed both SDD and ONS surgeries for each data point. Survey links were sent to patients via electronic mail with a response rate of 78%. Responses were recorded with the web-based program Redcap that is specifically designed to support online and offline data capture for research studies and operations. Sixty-three percent preferred SDD, 12 percent had no preference and 25 percent preferred ONS. “Our survey sought to determine patient perceptions of same-day discharge relative to overnight stay after total joint arthroplasty and is the first to assess perceptions in patients who have experienced both overnight stay and same-day discharge after total joint arthroplasty, “ noted Park. “This is the only population who can make a direct comparison between experiences. By specifically studying these patients we believe the most well-informed preferences are being collected.”

There were no statistically significant differences for any of these except the patients’ perception of the safety of SDD versus ONS. Patients preferring SDD reported being more comfortable at home and being safer from illnesses. Those preferring ONS felt their concerns and pain were better addressed in a hospital setting. Although most surveyed patients preferred SDD, the results may vary for older demographics that may need more extensive hands-on care after TJAs. “Patient education will continue to be the biggest factor in improving patient satisfaction after SDD. Future studies will look at ways to improve patients’ perception of safety, pain control, and the availability of staff to address their concerns,” Park added.