title: Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications.
abstract: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population.
  
  
  
  Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database.
  
  
  
  In total, 7474 primary TJAs among 120,847 TJA patients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population.
  
  
  
  Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Alex
authors.initials: A
authors.lastname: Sher
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Aakash
authors.initials: A
authors.lastname: Keswani
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Dong-Han
authors.initials: DH
authors.lastname: Yao
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Anderson
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas, Integrated Practice Unit for Musculoskeletal Care, Austin, Texas.
authors.forename: Karl
authors.initials: K
authors.lastname: Koenig
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Calin S
authors.initials: CS
authors.lastname: Moucha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001826:Body Fluids; D016208:Databases, Factual; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D058996:Quality Improvement; D012307:Risk Factors; D012907:Smoking; D066231:Surgeons
keywords: expedited discharge; hip arthroplasty; knee arthroplasty; outpatient surgery; patient selection criteria; same-day discharge