Same-Day Discharge Total Knee Arthroplasty in Octogenarians

Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients

BACKGROUND AND OBJECTIVE

Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR.

MATERIALS AND METHODS

We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores.

RESULTS

The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1.

CONCLUSIONS

The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.

[Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients

BACKGROUND AND OBJECTIVE

Frailty scores have not been standardised for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR.

MATERIALS AND METHODS

We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores.

RESULTS

The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67; ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1.

CONCLUSIONS

The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.

Half of all hip and knee arthroplasty patients may be potential day-case candidates: a nationwide register study of 166,730 procedures

BACKGROUND AND PURPOSE

The overall potential pool of day-case candidates on a national level in hip and knee arthroplasty is unknown. We aimed to estimate the proportion of hip and knee arthroplasty patients eligible for day-case surgery based on contemporary widely used criteria and determine whether there has been a change in the proportion of eligible patients over time and, secondarily, to investigate the proportion of eligible patients discharged on the day of surgery.

METHODS

Based on data from the Danish National Patient Register, we identified all patients undergoing primary unilateral hip or knee arthroplasty from January 2010 to March 2020. Using a modification of day-case eligibility criteria proposed by a national multicenter collaboration, we sorted patients into either day-case eligible or ineligible. A day-case procedure was defined as discharge on the day of surgery.

RESULTS

We included patients comprising a total of 166,730 primary total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA). 48% (95% confidence interval [CI] 48-49) were eligible for day-case surgery, with a decline from 50% (CI 49-51) in 2010 to 46% (CI 46-47) eligible in 2019. More UKA patients were day-case eligible (55%, CI 54-56) than THA (47%, CI 47-48) and TKA patients (49%, CI 48-49). A maximum of 8.0% (CI 7.4-8.5) of eligible patients were discharged on the day of surgery in 2019.

CONCLUSION

48% of the Danish hip and knee arthroplasty patients were potential day-case candidates, with a small decline in eligibility from 50% in 2010 to 46% in 2019. Day of surgery discharge among day-case eligible patients peaked at 8% in 2019. Thus, the potential for more day-case surgery seems large.

Is Discharge Within a Day Following Total Hip Arthroplasty Safe in the Septuagenarian and Octogenarian Population? A Propensity-Matched Cohort Study

BACKGROUND

Limited data exists on whether patients older than 70 can safely be discharged within a day (rapid discharge (RD)) following primary total hip arthroplasty (THA). The purpose of this study was to compare perioperative complications and readmission rates associated with RD in patients ≥70 years compared to longer lengths of stay following THA.

METHODS

A retrospective, propensity-matched cohort study was conducted using the National Surgical Quality Improvement Program database from 2006 to 2020. Patients ≥70 years undergoing RD following THA were propensity matched to patients ≥70 years who had longer hospital stays (nonrapid discharge). Sub-analyses were performed for septuagenarians and octogenarians. Following 1:1 matching, multivariate analyses were performed to compare perioperative complications and readmissions. Following propensity matching, both groups contained 2,192 patients.

RESULTS

The RD patients were found to have shorter operative times (P < .001), less bleeding complications (P < .001), and were more likely to have home discharges (P < .001). The 2 cohorts did not differ in the remaining complications or 30-day postoperative period readmissions among all patients and when evaluating septuagenarians and octogenarians.

CONCLUSION

Patients ≥70 years undergoing RD following THA had comparable complication and readmission rates to patients older than 70 undergoing nonrapid discharge. Furthermore, RD patients were more likely to have home discharges and have shorter operations with less bleeding complications. Septuagenarians receiving RD were more likely to have an unplanned readmission. These data suggest that RD following THA can be performed safely in select patients older than 70.

Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors

BACKGROUND CONTEXT

Although outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern.

PURPOSE

This study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population.

STUDY DESIGN/SETTING

Retrospective cohort study.

PATIENT SAMPLE

Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database.

OUTCOME MEASURES

Hospital readmission within 30 postoperative days.

METHODS

Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission.

RESULTS

A total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all).

CONCLUSION

This study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.