The Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty.

Abstract

Total hip (THA) and knee arthroplasty (TKA) rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge (SDD). This study examined the relationship between resilience and success of SDD in patients undergoing primary THA and TKA. A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated Two-Item Form [PSEQ-2]) on SDD rates and patient-reported outcome measures (PROMs) at 3 months and 1 year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of SDD success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs. Of the cohort of 700 (TKA) patients, after controlling for confounding factors such as age and body mass index patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 THA patients, again after controlling for confounding factors such as age and body mass index, patients who were discharged home on the day of surgery trended toward significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at 3 months and 1 year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs. Preoperative resiliency scores were significantly higher in patients undergoing primary THA and TKA that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.