Do Patients Sleep Better at Home or in the Hospital Following Primary Total Joint Arthroplasty?

Abstract

Despite increasing primary total joint arthroplasty (total knee arthroplasty [TKA] and total hip arthroplasty [THA]) rates in the United States, research on its impact on sleep quality is limited. The potential benefits of same-day discharge (SDD) post-total joint arthroplasty on sleep quality remain unexplored. This study examined whether patients undergoing SDD or overnight hospitalization experienced better sleep on the first night after surgery. In this prospective cohort study, patients undergoing THA or TKA were stratified by discharge status: SDD or overnight. The first postoperative night's sleep was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ), the Insomnia Severity Index (ISI), and Fitbit-derived total sleep time (TST). Group differences were evaluated using analyses of covariance adjusted for age, sex, body mass index, Charlson Comorbidity Index, anesthesia type, and baseline ISI. For THA, SDD was associated with higher RCSQ scores across several domains, including Total Score (d = 0.84, P = 0.0058), Sleep Depth (d = 0.82, P = 0.005), and Noise Disturbance (d = 1.22, P < 0.0001). Postoperative ISI was lower in SDD patients (d = 0.62, P = 0.010), and TST was longer (d = 1.03, P = 0.010). Higher postoperative ISI scores were strongly correlated with lower RCSQ and TST values. For TKA, SDD patients reported modest improvements in sleep depth (d = 0.59, P = 0.04) and noise disturbance (d = 0.97, P = 0.012), but no differences were found in total RCSQ, ISI, or TST (all P-values >0.05). Associations between ISI, RCSQ, and TST were weak. An SDD was associated with better early postoperative sleep after THA, including higher perceived quality and longer duration. While sleep benefits after TKA were more domain-specific, reductions in environmental disturbances suggest meaningful improvements in select aspects of rest. These findings support sleep as a modifiable perioperative outcome and support incorporating sleep quality into discharge planning.