An Increase in Same-day Discharge After Total Joint Arthroplasty During the COVID-19 Pandemic Does Not Influence Patient Outcomes: A Retrospective Cohort Analysis

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2023 Feb 13

PMID 36776732

Authors

Brook A Mitchell

Liam M Cleary

Linsen T Samuel

Benjamin R Coobs

Miles A Thomas

Stephen C Martinkovich

Joseph T Moskal

Affiliations

Soon will be listed here.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic caused major transitions in total joint arthroplasty (TJA), notably with the increased utilization of same-day discharge (SDD) pathways. This study assessed the effect of accelerated discharge pathways following the resumption of elective cases during the COVID-19 pandemic on SDD rates, adverse events, and characteristics associated with successful SDD following total hip and total knee arthroplasty.

Methods: This retrospective study split patients into cohorts: TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following the resumption of elective surgeries (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index, American Society of Anesthesiologists score, and pertinent comorbidities were analyzed, and length of stay, 30-day emergency department (ED) visit rates, readmissions, and reoperations were compared.

Results: A total of 1333 patients met inclusion criteria that were divided into pre-COVID (692) and post-COVID (641) cohorts. The pre-COVID group had a median age of 69 years (interquartile range 63-76), and the post-COVID group had a median age of 68 years (interquartile range 61-75) ( = .024). SDD increased from 0.1% to 28.9% ( < .001), and length of stay decreased from 1.3 days to 0.89 days ( < .001). There was no change in 30-day ED visits, readmissions, or reoperations ( = .817, = .470, and = .643, respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age ( < .001, odds ratio [OR] = 0.94), body mass index ( = .006, OR = 0.95), male sex ( < .001, OR = 1.83), and history of tobacco use ( < .001, OR = 1.87).

Conclusions: At our institution, the COVID-19 pandemic accelerated the utilization of SDD pathways without increasing ED visits, readmissions, or reoperations.

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