Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population

Same-Day Discharge Does Not Increase Resource Utilization within One Year of Total Joint Arthroplasty

INTRODUCTION

While the safety of rapid recovery TJA is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge-and its associated presumed reduction in hospital-based postoperative care and education-translates to the need for more postoperative support during the one-year recovery period.

MATERIALS AND METHODS

A retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with TJA providers at our institution during the one-year postoperative period. Secondary outcomes included 30-day emergency department (ED) returns, readmissions, one-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients.

RESULTS

In both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists (ASA) score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, ED returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in PROMIS-PF scores.

CONCLUSION

After risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA.

Are We Moving in the Right Direction? Demographic and Outcome Trends in Same-day Total Hip Arthroplasty From 2015 to 2020

INTRODUCTION

Understanding the trends among patients undergoing same-day discharge (SDD) total hip arthroplasty (THA) is imperative to highlight the progression of outpatient surgery and the criteria used for enrollment. The purpose of this study was to identify trends in demographic characteristics and outcomes among patients who participated in an academic hospital SDD THA program over 6 years.

METHODS

We retrospectively reviewed all patients who enrolled in our institution's SDD THA program from January 2015 to October 2020. Patient demographics, failure-to-launch rate, as well as readmission and revision rates were evaluated. Trends for continuous variables were analyzed using analysis of variance, and categorical variables were analyzed using chi-square tests.

RESULTS

In total, 1,334 patients participated in our SDD THA program between 2015 and 2020. Age (54.82 to 57.94 years; P < 0.001) and mean Charlson Comorbidity Index (2.15 to 2.90; P < 0.001) significantly differed over the 6-year period. More African Americans (4.3 to 12.3%; P = 0.003) and American Society of Anesthesiology class III (3.2% to 5.8%; P < 0.001) patients enrolled in the program over time. Sex ( P = 0.069), BMI ( P = 0.081), marital status ( P = 0.069), and smoking status ( P = 0.186) did not statistically differ. Although the failure-to-launch rate (0.0% to 12.0%; P < 0.001) increased over time, the 90-day readmissions ( P = 0.204) and 90-day revisions ( P = 0.110) did not statistically differ.

CONCLUSION

More African Americans, older aged individuals, and patients with higher preexisting comorbidity burden enrolled in the program over this period. Our findings are a reflection of a more inclusive selection criterion for participation in the SDD THA program. These results highlight the potential increase in the number of patients and surgeons interested in SDD THA, which is paramount in the current incentivized and value-based healthcare environment.

LEVEL EVIDENCE

III, Retrospective Review.

Patient Perceptions of Same-Day Discharge Versus Overnight Stay After Total Joint Arthroplasty: Results of a Survey

Background

In the COVID-19 era, there has been increasing interest in same-day discharge (SDD) after total joint arthroplasty (TJA). However, patient perception of SDD is not well reported.

Purpose

We sought to understand patients' perceptions and preferences of postoperative care by surveying patients who have completed both an overnight stay (ONS) and an SDD after TJA.

Methods

We emailed survey links to 67 patients who previously underwent either 2 total hip arthroplasties (THAs) or 2 total knee arthroplasties (TKAs).

Results

Fifty-two patients (78%) responded to the survey. Thirty-four (65%) patients underwent staged, bilateral TKAs, and 18 (35%) patients underwent staged, bilateral THAs. Overall, 63% of patients preferred their SDD, 12% had no preference, and 25% preferred their ONS, with no difference in preference between TKA and THA groups. Those who preferred their SDD reported being more comfortable at home. Those who preferred their ONS felt their pain and concerns were better addressed. No differences were found in comfort, sleep quality, appetite, burden on family, return to function, feelings of being discharged too soon, overall experience, 30-day emergency department (ED) visits, or readmissions within 30 days between patients' SDD and ONS. There was a small statistically significant difference between patients' perception of safety between SDD and ONS.

Conclusion

Our survey found that most patients reported a preference for SDD after TJA over ONS. Although there was a small difference in patient perception of safety, there were no differences in return to the ED or readmissions after SDD and ONS.

Outpatient Total Joint Arthroplasty at a High-Volume Academic Center: An Analysis of Failure to Launch

BACKGROUND

Unanticipated failure to discharge home (failure to launch, FTL) following scheduled same-day discharge (SDD) total joint arthroplasty (TJA) is problematic for the surgical facility with respect to staffing, care coordination, and reimbursement concerns. The aim of this study was to review rates, etiologies, and contributing factors for FTL in SDD TJA at an inpatient academic medical center.

METHODS

All patients who underwent primary TJA between February 2021 and February 2023 were retrospectively reviewed. Of those scheduled for SDD, risk factors for FTL were compared with successful SDD. Readmission and emergency department (ED) visits were compared with historical cohorts. There were 3,093 consecutive primary joint arthroplasties performed, of which 2,411 (78%) were scheduled for SDD.

RESULTS

Overall, SDD was successful in 94.2% (n = 2,272) of patients who had an FTL rate of 5.8%. Specifically, SDD was successful in 91.4% with total hip arthroplasty, 96.0% with total knee arthroplasty, and 98.6% with unicompartmental knee arthroplasty. Factors that significantly increased the risk of FTL included general anesthesia versus spinal anesthesia (P < .0001), later surgery start time (P < .0001), longer surgical time (P = .0043), higher estimated blood loss (P < .0001), women (P = .0102), younger age (P = .0079), and lower preoperative mental health patient-reported outcomes scores (P = .0039). Readmission and ED visit rates were not higher in the SDD group when compared to historical controls (P = .6830).

CONCLUSIONS

With a comprehensive multidisciplinary approach dedicated to improving SDDs at an academic medical center, we have seen successful SDD in nearly 80% of primary TJA, with an FTL rate of 5.8%, and no increased risk of readmission or ED visits. Without adding many personnel, hospital recovery units, or other resources, simple interventions to help decrease FTL have included enhanced preoperative education and expectation settings, improved perioperative communications, reallocating personnel from the inpatient to the outpatient setting, the use of short-acting spinal anesthetics, and earlier scheduled surgery times.

Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes

INTRODUCTION

The COVID-19 pandemic has significantly affected access to timely care for patients with hip osteoarthritis requiring total hip replacement (THR). This study aimed to assess the changes in surgical activity, outpatient treatment, length of stay (LOS), discharge destinations, readmission rates, clinical outcomes, and patient satisfaction before and after the pandemic at our institution.

MATERIALS AND METHODS

This retrospective study encompassed patients undergoing primary THR through the direct anterior approach at a single university hospital. Data on demographic characteristics, surgical technique, perioperative management, LOS, discharge destinations, complications, and clinical outcomes were collected. Furthermore, a comparative analysis between the pre-pandemic (2019) and post-pandemic (2022) periods was conducted.

RESULTS

There was a 14% increase in surgical activity post-pandemic, with 214 patients undergoing surgery in 2019 versus 284 in 2022. The percentage of patients managed as outpatients significantly increased from 0.5% in 2019 to 29.6% in 2022 (p < 0.001). LOS decreased from 2.7 ± 1 [0-8] days to 1.4 ± 1.1 [0-12] days (p < 0.001), and the rate of discharge to rehabilitation centres declined from 21.5% to 8.8% (p < 0.001). No significant increase in the readmission rates was observed (1.4% in both periods). At two months postoperatively, the mean HHS and satisfaction rates were comparable between the two groups (p = 1 and p = 0.73, respectively).

DISCUSSION

Despite the challenges posed by the COVID-19 pandemic, surgical activity at our institution demonstrated an increase compared to the pre-pandemic levels by expanding outpatient care, reducing LOS, and increasing rates of home discharges. Importantly, these changes did not adversely affect rehospitalization rates or early clinical outcomes.

LEVEL OF EVIDENCE

IV.

Safety of Outpatient Total Hip Arthroplasty Performed in Patients 65 Years of Age and Older in an Ambulatory Surgery Center

Studies regarding the safety of same day discharge (SDD) in patients ≥65 years of age undergoing total hip arthroplasty (THA) are lacking. A retrospective review of 69 patients undergoing SDD following primary THA in 2 free-standing ambulatory surgical centers (ASCs) was performed to evaluate for safety and complications. Sixty-six patients met SDD goals, while 1 patient required transport to a hospital for transfusion, and 2 patients underwent overnight observation in the ASC. This study reveals that with appropriate preoperative evaluation, patient selection, and education, THA in a free-standing ASC can be safely performed in patients ≥65 years of age.

Inconsistent Classification of "Outpatient" Surgeries Leads to Different Outcomes Following Total Hip Arthroplasty in Medicare Beneficiaries: A Critical Analysis

BACKGROUND

With rising utilization of outpatient total hip arthroplasty (THA) in older patients including Medicare beneficiaries, the objective was to compare differences in definition including (1) patient demographics; (2) lengths of stay (LOS); and (3) outcomes of "outpatient" (stated status) versus "same-day discharge" (SDD) (actual LOS = 0 days) utilizing a nationwide database.

METHODS

A national database from 2015 to 2019 was queried for Medicare-aged patients undergoing outpatient THA. Total outpatient THAs (N = 6,072) were defined in one of 2 ways: either "outpatient" by the hospital (N = 2,003) or LOS = 0 days (N = 4,069). Demographics, LOS, discharge destinations, and complications were compared between groups. Logistic regression models computed odds ratios (ORs) for factors leading to complications, readmissions, and nonhome discharges. P values < .008 were significant.

RESULTS

Women (OR: 1.19, P = .002), diabetes mellitus (OR: 1.31, P = .003), general anesthesia (OR: 1.24, P = .001), and longer operative times (≥95 minutes) (OR: 1.82, P < .001) were associated with 'outpatient' designation versus SDD. Within the hospital-defined 'outpatient' cohort, 49.1% (983 of 2,003) were discharged the same day (LOS = 0 days), and 21.8% had LOS 2 or more days. The hospital-defined 'outpatient' cohort had greater odds of nonhome discharges (6.3 versus 2.8%; OR: 1.88, P < .001) compared to SDD surgeries. The incidence was higher for any complication among hospital-defined 'outpatient' designated patients compared to SDD (5.5 versus 3.9%, P = .007).

CONCLUSIONS

Outpatient surgeries may be misleading and often do not correlate with SDD, as over 20% remain in the hospital 2 or more days. Investigators should quantitatively define the "outpatient" status by actual LOS to allow standardization and results comparison.

LEVEL OF EVIDENCE

III.

Minimizing Opioid Use After Total Hip Arthroplasty: Comparing Periarticular Injection Versus Patient-Controlled Epidural Analgesia Versus a Combination Protocol

BACKGROUND

Effective management of postoperative pain after total hip arthroplasty (THA) may be challenging. We sought to develop an opioid-sparing pain management pathway by comparing the relative effectiveness of 3 different protocols: (1) Local anesthetic administered patient-controlled epidural analgesia (PCEA) without intrathecal opioids; (2) Periarticular injection (PAI); and (3) PCEA + PAI.

METHODS

In this double-blinded randomized controlled trial, 180 patients undergoing THA were randomized to receive either (1) PCEA with 0.06% bupivacaine, (2) PAI, or (3) a PAI + PCEA with 0.06% bupivacaine. All patients received the same postoperative multimodal analgesic regimen. The primary outcome was opioid consumption, measured in oral morphine equivalents, at 24, 48, and 72 hours after anesthesia stop time. Secondary measures included pain at rest and with movement, opioid side effects, patient satisfaction, and quality of recovery, as assessed via standardized self-reporting scales and surveys.

RESULTS

Opioid consumption was significantly higher in the PAI group in the first 24 hours postoperatively compared to the PAI + PCEA group (30 versus 15, P = .012). No differences were detected among groups for length of stay, pain scores, patient satisfaction, or duration of surgery. More patients in the PAI + PCEA group were opiate-free in the first 24 hours compared to PAI (23.7 versus 8.5%, P = .043).

CONCLUSION

Use of PAI + PCEA regimen was opioid-sparing in the first 24 hours after surgery, favoring this group when opioid reduction is desired. Increased drowsiness was noted in the subsequent 24 to 48 hours once the epidural catheter was removed and opioid consumption also increased.

Identifying Risk Factors for Complication and Readmission with Same-Day Discharge Arthroplasty

BACKGROUND

The COVID-19 pandemic caused a surge of same-day discharge (SDD) for total joint arthroplasty. However, SDD may not be beneficial for all patients. Therefore, continued investigation into the safety of SDD is necessary as well as risk stratification for improved patient outcomes.

METHODS

This retrospective cohort study examined 31,851 elective SDD hip and knee arthroplasties from 2016 to 2020 in a large national database. Logistic regression models were used to identify patient variables and preoperative comorbidities that contribute to postoperative complication or readmission with SDD. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated.

RESULTS

SDD increased from 1.4% in 2016 to 14.6% in 2020. SDD is associated with lower odds of readmission (AOR: 0.994, CI: 0.992-0.996) and postoperative complications (AOR: 0.998, CI: 0.997-1.000). Patients who have preoperative dyspnea (AOR: 1.03, CI: 1.02-1.04, P < .001), chronic obstructive pulmonary disease (AOR: 1.02, CI: 1.01-1.03, P = .002), and hypoalbuminemia (AOR: 1.02, CI: 1.00-1.03, P < .001), had higher odds of postoperative complications. Patients who had preoperative dyspnea (AOR: 1.02, CI: 1.01-1.03), hypertension (AOR: 1.01, CI: 1.01-1.03, P = .003), chronic corticosteroid use (AOR: 1.02, CI: 1.01-1.03, P < .001), bleeding disorder (AOR: 1.02; CI: 1.01-1.03, P < .001), and hypoalbuminemia (AOR: 1.01, CI: 1.00-1.02, P = .038), had higher odds of readmission.

CONCLUSION

SDD is safe with certain comorbidities. Preoperative screening for cardiopulmonary comorbidities (eg, dyspnea, hypertension, and chronic obstructive pulmonary disease), chronic corticosteroid use, bleeding disorder, and hypoalbuminemia may improve SDD outcomes.

Ambulatory total hip arthroplasty: Causes for failure to launch and associated risk factors

Aims

The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD.

Methods

This retrospective cohort study followed pre-selected patients for SDD THA from 1 August 2018 to 31 December 2020. Inclusion criteria were patients undergoing unilateral THA with appropriate social support, age 18 to 75 years, and BMI < 37 kg/m². Patients with opioid dependence, coronary artery disease, and valvular heart disease were excluded. Demographics, comorbidities, and perioperative data were collected from the electronic medical records. Possible risk factors for failed SDD were identified using multivariate logistic regression.

Results

In all, 278 patients were identified with a mean age of 57.1 years (SD 8.1) and a mean BMI of 27.3 kg/m² (SD 4.5). A total of 96 patients failed SDD, with the most common reasons being failure to clear physical therapy (26%), dizziness (22%), and postoperative nausea and vomiting (11%). Risk factors associated with failed SDD included smokers (odds ratio (OR) 6.24; p = 0.009), a maximum postoperative pain score > 8 (OR 4.76; p = 0.004), and procedures starting after 11 am (OR 2.28; p = 0.015). A higher postoperative tolerable pain goal (numerical rating scale 4 to 10) was found to be associated with successful SDD (OR 2.7; p = 0.001). Age, BMI, surgical approach, American Society of Anesthesiologists grade, and anaesthesia type were not associated with failed SDD.

Conclusion

SDD is a safe and viable option for pre-selected patients interested in rapid recovery THA. The most common causes for failure to launch were failing to clear physical thereapy and patient symptomatology. Risk factors associated with failed SSD highlight the importance of preoperative counselling regarding smoking cessation and postoperative pain to set reasonable expectations. Future interventions should aim to improve patient postoperative mobilization, pain control, and decrease symptomatology.

Cite this article: Bone Jt Open 2022;3(9):684–691.

A Formal Same-Day Discharge Total Joint Arthroplasty Program May Not Be Necessary: A Propensity-Matched Cohort Study

BACKGROUND

Same-day discharge (SDD) total joint arthroplasty (TJA) programs often have stringent selection criteria. Some patients deemed ineligible may nonetheless be discharged on the day of surgery. This study compares the outcomes between patients enrolled in our SDD TJA program who were SDD to those who did not participate in the program but were also SDD.

METHODS

We retrospectively reviewed all patients who were SDD following TJA from 2015 to 2020. Patients were stratified into two cohorts based on whether they were formally enrolled in our institution's SDD TJA program. Propensity-score matching was performed to limit confounding and independent sample t-tests or Pearson's chi-squared tests were used to compare outcomes of interest between the matched groups.

RESULTS

Of the 1778 patients included, 1384 (78%) completed the SDD TJA program and 394 (22%) were SDD but did not participate in the SDD TJA program. Upon 1:1 propensity-score matching, a total of 550 patients were matched for comparison. The surgical time was significantly longer for patients who did not participate in the SDD TJA program compared to those who participated in the program (109.39 vs 87.29 minutes; P < .001). Discharge disposition (P = .999), 90-day emergency department visits (P = .476), 90-day all-cause readmissions (P = .999), 90-day all-cause revisions (P = .563), and Hip disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS, JR) and Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement at all time points did not significantly differ.

CONCLUSION

Enrollment in a formal SDD TJA program may not be a necessary precursor to achieving similar outcomes following TJA for patients who are SDD without formally enrolling. Therefore, a formal program may no longer be needed at an institution with well-established evidence-based protocols with strong success and an experience with value-based care.

LEVEL III EVIDENCE

Retrospective Cohort Study.

Same-Day Discharge Total Hip and Knee Arthroplasty: Trends, Complications, and Readmission Rates

BACKGROUND

Although total hip arthroplasty (THA) and total knee arthroplasty (TKA) are transitioning to surgery centers, there remain limited data on trends, comorbidities, and complications in patients discharged the same day of surgery. In addition, many studies are limited to the Medicare population, excluding a large proportion of outpatient surgery patients.

METHODS

Primary, elective THA/TKA cases between 2010 and 2017 were retrospectively identified using the PearlDiver All-Payer Database and separated based on surgery as well as same-day discharge (SDD) or non-SDD. Data were collected on demographics, rates, comorbidities, and complications. Multivariable logistic regression determined adjusted odds ratios (ORs) for 90-day complications requiring readmission for each group.

RESULTS

In total, 1,789,601 (68.8% TKA, 31.2% THA) patients were identified where 2.9% of TKAs and 2.2% of THAs were SDD. Annual SDD rates are increasing, with a 15.8% mean annual change for SDD-THA and 11.1% for SDD-TKA (P < .001). SDD patients were younger with fewer comorbidities (P < .001). Regression analysis showed an overall slightly higher OR of complications requiring readmission for SDD-TKA vs non-SDD-TKA (OR 1.14, 95% confidence interval [CI] 1.07-1.21, P < .001). There was no significant difference for SDD-THA vs non-SDD-THA (OR 1.03, 95% CI 0.94-1.13, P = .49). In univariate analysis, SDD-THA vs SDD-TKA had more mechanical complications (P < .001), but less pulmonary embolisms (P < .001). Regression analysis showed a slightly higher risk of complications for SDD-THA vs SDD-TKA (OR 1.19, 95% CI 0.99-1.44, P = .05).

CONCLUSION

The prevalence of SDD is rising. SDD-THA is increasing more rapidly than SDD-TKA. SDD patients are generally younger with fewer comorbidities. SDD-TKA has slightly higher odds of complications requiring readmission than non-SDD-TKA. SDD-THA and SDD-TKA have different complication profiles.

Risk Factors for Discharge to a Non-Home Destination and Reoperation Following Outpatient Total Hip Arthroplasty (THA) in Medicare-Eligible Patients

Introduction:

The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only (IO) list in January 2020. Given this recommendation, we analyzed Medicare-eligible patients undergoing outpatient THA to understand risk factors for nonroutine discharge, reoperations, and readmissions.

Materials and Methods:

The 2015-2018 American College of Surgeons–National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27130 for Medicare eligible patients (≥ 65 years of age) undergoing outpatient THA. Postoperative discharge destination was categorized into home and non-home. Multivariate logistic regression models were used to evaluate risk factors associated with non-home discharge disposition. Secondarily, we evaluated rates and risk factors associated with 30-day reoperations and readmissions.

Results:

A total of 1095 THAs were retrieved for final analysis. A total of 108 patients (9.9%) experienced a non-home discharge postoperatively. Patients were discharged to rehab (n = 47; 4.3%), a skilled care facility (n = 47; 4.3%), a facility that was “home” (n = 8; 0.7%), a separate acute care facility (n = 5; 0.5%), or an unskilled facility (n = 1; 0.1%). Independent factors for a non-home discharge were American Society of Anesthesiologists Class >II (odds ratio [OR] 2.74), operative time >80 minutes (OR 2.42), age >70 years (OR 2.20), and female gender (OR 1.67). Eighteen patients (1.6%) required an unplanned reoperation within 30 days. A total of 40 patients (3.7%) required 30-day readmissions, with 35 readmissions related to the original THA procedure. Independent risk factors for 30-day reoperation were COPD (OR 5.85) and HTN (OR 5.24). Independent risk factors for 30-day readmission were HTN (OR 4.35) and Age >70 (OR 2.48).

Discussion:

The current study identifies significant predictors associated with a non-home discharge, reoperation, and readmission in Medicare-aged patients undergoing outpatient THA.

Conclusion:

Providers should consider preoperatively risk-stratifying patients to reduce the costs associated with unplanned discharge destination, complication or reoperation.

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

BACKGROUND

Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later).

METHODS

In total, 530 aseptic rTJAs performed at a single tertiary care referral center (December 5, 2011 to December 30, 2019) were identified. Early and later discharge patients were matched as closely as possible on procedure type, sex, American Society of Anesthesiologists physical status classification, age, and body mass index. All patients were optimized using modern perioperative protocols. The rate of 90-day emergency department (ED) visits and hospital admissions was compared between groups.

RESULTS

In total, 183 early discharge rTJAs (54 hips, 129 knees) in 178 patients were matched to 183 later discharge rTJAs (71 hips, 112 knees) in 165 patients. Sixty-two percent of the sample was female, with an overall average age and body mass index of 63 ± 9.9 (range: 18-92) years and 32 ± 6.9 (range: 18-58) kg/m². There was no statistical difference in 90-day ED visit rates between early (6/178, 3.4%) and later (11/165, 6.7%) discharge patients (P = .214). Ninety-day hospital admission rates for early (7/178, 3.9%) and later (4/165, 2.4%) discharges did not differ (P = .545).

CONCLUSION

Using modern perioperative protocols with appropriate patient selection, early discharge following aseptic rTJA does not increase 90-day readmissions or ED visits. As hospital inpatient capacity remains limited due to COVID-19, select rTJA patients may safely discharge home the same or next day to preserve hospital beds and resources for more critical illness.

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

BACKGROUND

Recently, the practice of ordering routine postoperative laboratory tests in primary total hip arthroplasty (THA) has been challenged. This study aimed to evaluate the utility of routine postoperative laboratory tests after primary elective THA in an Asian population and identify the risk factors associated with abnormal postoperative laboratory test-related intervention.

METHODS

We retrospectively reviewed 395 consecutive patients who underwent primary elective THA at a single tertiary academic center. Patient clinical information and laboratory test results were collected for analysis.

RESULTS

A total of 349 (88.4%) patients had abnormal postoperative laboratory test results; most patients had anemia and hypoalbuminemia. Twenty-seven (6.8%) patients received clinical intervention. Of the 307 (77.7%) patients with postoperative anemia, 7 patients received blood transfusion. Factors associated with transfusion were female gender, low body mass index, long operation time, and low preoperative hemoglobin levels. Of the 149 (37.7%) patients with postoperative hypoalbuminemia, 16 received albumin supplementation. Factors associated with albumin supplementation were female gender, long operation time, and low preoperative albumin levels. Although 36 patients had abnormal postoperative creatinine, only 1 patient required specialist consultation. For electrolyte abnormalities, hyponatremia was noted; however, no patient received sodium supplementation. Moreover, 14 patients developed hypokalemia, of which 6 required potassium supplementation; 163 patients had hypocalcemia, of which 2 received calcium supplementation.

CONCLUSION

Routine laboratory tests after primary elective THA are unnecessary for most of the patients in modern clinical practice. However, for those with identified risk factors, postoperative laboratory tests still should be performed.

Can outpatient total hip arthroplasty be safely performed in the Caribbean? A case report

Over the past decade, outpatient total hip arthroplasty has been performed successfully with increasing frequency in the United States. The principles for success have been the focus of many recent publications. Despite this, there remains scepticism among surgeons as to the generalisability of outpatient arthroplasty. In the Caribbean basin, our challenges are different from those faced in the high-resource world, but increased patient demand, the shift towards value-based healthcare and the natural evolution of the procedure is likely to result in hip arthroplasty transitioning into the outpatient setting. The present case report describes a patient's surgical journey through outpatient hip arthroplasty in a developing country. To the best of my knowledge, this case is the first report of a successful outpatient total hip arthroplasty in the Caribbean.