A recent study published in the Journal of Bone & Joint Surgery examined same-day discharge following total joint replacement in patients considered to be at increased risk for adverse events. ^[1]Reddy NC, Prentice HA, Paxton EW, et al. Association Between Same-Day Discharge Total Joint Arthroplasty and Risk of 90-Day Adverse Events in Patients with ASA Classification of ≥3. J Bone Joint … Continue reading Previous studies looking at the feasibility of same-day discharge have focused on relatively young and healthy populations, limiting their usefulness across groups most likely to need joint replacement. The study was conducted at a large, multiregional health system which has adopted a formal same-day rapid recovery total joint program as part of an effort to reduce overall length of stay. The program provides preoperative education, case managers, and home physical therapy for all patients, along with specific criteria which must be met in order to be discharged.

This was an observational study comparing short term adverse events for inpatients versus those following same-day discharge.  The authors utilized data from the Kaiser Permanente Total Joint Replacement Registry. The population consisted of approximately 15,000 patients who underwent elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) due to osteoarthritis and were considered to be at increased risk based on an American Society of Anesthesiologists (ASA) classification of 3 or greater.

Variables reported for each group included demographic data, comorbidities, type of anesthesia, and surgical techniques.  Outcomes of interest included emergency department visits within 90 days of discharge, unplanned readmission, complications, and mortality. Complications included cardiac events, deep infection, and venous thrombosis.

The study found that overall, same-day discharge did not increase the risk of emergency department visits, unplanned readmission or complications compared with an inpatient stay following TKA or THA. Factors associated with a higher rate of ED visits included chronic pulmonary disease, hypothyroidism, and obesity among others. Older age, coagulopathy, congestive heart failure, and peripheral vascular disease were among the factors associated with a higher risk of complications.

Based on these findings the authors suggest that is possible to expand indications for same-day discharge in a hospital setting to include a more diverse group of patients, provided that protocols are in place to ensure patient safety and minimize risk.

Per Dr. Richard Valdesuso, national medical director of Carelon’s musculoskeletal programs:

“This study adds to a growing body of evidence supporting a shift toward less intensive settings for certain procedures. While cost containment is a major driver, there are other factors favoring such a shift, among them patient preference and the increasing risks associated with hospitalization. Carelon currently offers a level of care assessment as part of our review process, thus reducing the administrative burden to both providers and payers.”