Safety of same-day total joint replacement: a population-based cohort study

Purpose — Total joint arthroplasty (TJA) has seen a rapid increase in same-day surgery (SDS), particularly since the COVID-19 pandemic. One limitation of prior research on this topic is that data derived from single (usually high volume) centers whose experience may not be generalizable. The purpose of this study was to analyze the success rates of same-day TJA using population level data in Canada’s most populous province.

Methods — Data from Ontario’s linked, administrative, healthcare databases were obtained for all patients undergoing planned outpatient elective total hip or knee arthroplasty (total hip arthroplasty [THA] or total knee arthroplasty [TKA]) between April 1 2016 and March 31, 2022. Rates of successful same-day TJA were calculated (ie, proportion of planned outpatients actually discharged same day). Predictors of successful same-day discharge were compared between the groups.

Results — Overall, 2,776 TKA and 3,380 THA patients planned for same-day discharge over the study period. This increased from 0.6% in 2016 to 23.8% in 2021 of patients selected for same-day surgery, 11.3% (TKA) and 11.6% (THA) failed same-day discharge. After matching on age, joint, Charlson score, type of institution, and year of surgery, female patients were markedly more likely to fail SDS TJA compared with male patients (hazard ratio: 1.14, 95% confidence interval, 1.05 to 1.25). Other predictors of unsuccessful same-day discharge included frailty, presence of comorbidities (for TKA), and Class III or higher obesity (for THA).

Conclusion — Rates of same-day surgery are rising rapidly, and nearly 90% of patients planned as same-day cases are successfully discharged as such. Female patients are at markedly higher risk of failed SDS TJA. Other risk factors include presence of comorbidities and frailty. It is important to evaluate SDS TJA programs to ensure that they are safe and accessible for female arthroplasty patients.