A new retrospective study of 84,864 patients who had been treated with primary total knee arthroplasty (TKA) asked the important question: does a 1-day discharge change complication rates when compared to a longer stay arthroplasty?
84,864 TKA Patient Study: How Risky Is 1-Day Discharge?
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The resulting study, “Hospital Discharge Within a Day After Total Knee Arthroplasty Does Not Affect 1-Year Complications Compared With Rapid Discharge,” is published in the May 1, 2021, edition of The Journal of the American Academy of Orthopaedic Surgeons.
Co-author Peter K. Sculco, M.D., hip and knee surgeon at Hospital for Special Surgery (HSS), explained the genesis of this important study to OTW, “Rapid recovery protocols have gained increasing popularity within the past decade. However, while rapid recovery protocols may be beneficial, some patients may benefit from more traditional protocols.”
“It has been unclear largely because rapid recovery protocols are a relatively new concept in the realm of arthroplasty. As arthroplasty continues to move more towards the realm of rapid recovery protocols, same-day discharges and into the ambulatory surgery setting, additional research is prudent in order to establish mid-term and long-term impact of these protocols.”
Mining the PearlDiver database for 2007-2017, the team of researchers grouped the patients into three cohorts:
- same day discharge (<24 hours postoperatively),
- rapid discharge (1 to 2 days), and
- traditional discharge (3 to 4 days).
The percentage of patients who had had same day discharge was 2.36% (2,004/84,864); the percentage with rapid discharge was 28.56% (24,235/84,864); and the percentage with traditional discharge was 69.08% (58,625/84,864).
“In our analysis, we noted no difference in complications when observing same day discharge patients compared to their traditional discharge counterparts. This signifies that rapid recovery protocols can be equally effective, if not potentially better, than traditional protocols. Rapid recovery protocols are safe and effective in the right patient.”
And what, OTW inquired, did the data show in terms of other interesting implications? According to Dr. Sculco, “During our analysis, we noticed that patients in the rapid recovery cohort had a lower rate of manipulation under anesthesia or periprosthetic joint infection. This further suggests that early mobilization and getting patients out of the hospital is not only beneficial from a cost perspective but can help improve outcomes.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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