Early Discharge after Total Hip and Knee Arthroplasty– An Observational Cohort Study Evaluating Safety in 330,000 Patients

Abstract Background There has been considerable interest in recent years for early discharge after arthroplasty surgery. We endeavoured to evaluate the safety of same day discharge given the rapid uptake of this practice approach. Methods This is a retrospective observational cohort study of the ACS-NSQIP registry database. We included patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2015 and 2018. We categorized length of stay (LoS) as same day discharge (LoS = 0 days), accelerated discharge (LoS = 1 day), and routine discharge (LoS 2-3 days). For each LoS cohort, we determined the incidence of major complications within 30 days (surgical site infection (SSI), reoperation, readmission, DVT, PE) and evaluated risk using multivariate logistic regression analysis if incidence was >1%. Patients undergoing THA and TKA were evaluated independently. Results The final study cohort consisted of 333, 212 patients, including 124, 150 that underwent THA (37%) and 209, 062 that had TKA (63%). In the THA same day discharge cohort, the incidence of superficial SSI (0.2%), deep/organ space SSI (0.3%), DVT (0.2%) and PE (0.2%) were low. The risk of reoperation was comparable to routine discharge (OR: 0.82, 95% CI 0.61-1.09, p =0.17) and readmission rate was significantly lower (OR: 0.60, 95% CI: 0.48-0.76, p Conclusion This large, observational, real-world study suggests that same day and accelerated discharge management is safe clinical practice for patients undergoing total joint arthroplasty, yielding a similar risk of major acute 30-day complications. Further clinical trials evaluating long term major outcomes, including patient reported outcomes and experiences, would offer further and definitive insight into this practice approach.