Trends in day-case hip and knee replacement in England : an analysis of National Joint Registry and Hospital Episode Statistics data.

Abstract

Hip and knee replacements are increasingly being performed as day-case procedures without an overnight stay in hospital. The aim of this study was to describe trends surrounding this practice for a national cohort of patients in England. The National Joint Registry and Hospital Episode Statistics were linked to identify patients who underwent NHS-funded total hip replacement (THR) and total or unicompartmental knee replacement (TKR/UKR) in England between January 2010 and March 2022. Trends in day-case surgery were described as counts and proportions of all inpatient procedures at national, regional, and local levels. Day-case patient and surgical characteristics were described and compared over time and by volume, using linear regression models, in relation to trends in inpatient procedures. A total of 1,455,842 procedures were included, of which 7,485 were day-cases: 2,420 THRs, 2,509 TKRs, and 2,556 UKRs. The rate of day-case surgery increased over time, with 52.9% of recorded day-case procedures occuring from 2019 onwards. Between 2016 and 2022, the proportion of procedures done as a day-case increased from 0.3% to 1.05% for THR, from 0.38% to 1.05% for TKR, and from 1.98% to 9.3% for UKR. Most of the increase in day-case activity occurred in NHS units. There was significant regional and local variation, with a small number of units accounting for most day-case procedures. Patients who underwent THR or TKR as a day-case were significantly younger and healthier than those who underwent these procedures as an inpatient, with a trend towards increasing selectivity over time. However, by contrast, higher-volume day-case units became slightly less selective for certain characteristics as volume increased. Although the number of major joint replacements being undertaken as a day-case has increased rapidly in England, particularly since the COVID-19 pandemic, this remains a small proportion of procedures compared with the rates in other contemporary healthcare settings.