The Same Day Discharges following Primary Total Knee Arthroplasty: A Single Surgeon, Propensity Score-Matched Cohort Analysis.

Abstract

This is a retrospective study. As new surgical techniques and improved perioperative care approaches have become available, the same-day discharge in selected total knee arthroplasty (TKA) patients was introduced to decrease health care costs without compromising outcomes. This study aimed to compare clinical and functional outcomes between same-day discharge TKA patients and inpatient-discharge TKA patients. A retrospective review of 100 consecutive patients with same-day discharge matched to a cohort of 300 patients with inpatient discharge that underwent TKA by a single surgeon at a tertiary referral center was conducted. Propensity-score matching was performed to adjust for baseline differences in preoperative patient demographics, medical comorbidities, and patient-reported outcome measures (PROMs) between both cohorts. All patients had a minimum of 1-year follow-up (range: 1.2-2.8 years). In terms of clinical outcomes for the propensity score-matched cohorts, there was no significant difference in terms of revision rates (1.0 vs. 1.3%, <i>p</i> = 0.76), 90-day emergency department visits (3.0 vs. 3.3%, <i>p</i> = 0.35), 30-day readmission rates (1.0 vs. 1.3%, <i>p</i> = 0.45), and 90-day readmission rates (3.0 vs. 3.6%, <i>p</i> = 0.69). Patients with same-day discharge demonstrated significantly higher postoperative PROM scores, at both 3-month and 1-year follow-up, for PROMIS-10 Physical Score (50 vs. 46, <i>p</i> = 0.028), PROMIS-10 Mental Score (56 vs. 53, <i>p</i> = 0.039), and Physical SF10A (57 vs. 52, <i>p</i> = 0.013). This study showed that patients with same-day discharge had similar clinical outcomes and superior functional outcomes, when compared with patients that had a standard inpatient protocol. This suggests that same-day discharge following TKA may be a safe, viable option in selected total knee joint arthroplasty patients.