Evaluation of Emergency Department Visits Following Total Joint Arthroplasty: Same-Day Discharge vs Non–Same-Day Discharge

• Published in: The Journal of arthroplasty Vol. 37; no. 6; pp. 1017 - 1022
• Main Authors: Singh, Vivek, Kurapatti, Mark, Anil, Utkarsh, Macaulay, William, Schwarzkopf, Ran, Davidovitch, Roy I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2022
• Subjects: Arthroplasty, Replacement, Hip - adverse effects; economic burden; emergency department; Emergency Service, Hospital; Humans; Length of Stay; Patient Discharge; Patient Readmission; Postoperative Complications - etiology; Retrospective Studies; Risk Factors; same-day discharge; total hip arthroplasty; total knee arthroplasty; total hip arthroplasty; total knee arthroplasty; same-day discharge; emergency department; economic burden
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.02.031

Traditionally, most efforts have focused on readmission rates while little has been reported on emergency department (ED) presentation. This study aims to analyze the difference between same-day discharge (SDD) and non-SDD primary total hip and knee arthroplasty cases to determine the rate and reasons associated with 90-day ED presentations. We retrospectively reviewed all patients who underwent primary total hip arthroplasty and total knee arthroplasty between 2011 and 2021. The patients were separated into 2 cohorts: (1) SDD and (2) required a longer length of stay. The primary outcome was an ED visit within 90 days of the index operation. Secondary outcomes included reasons for ED visits and readmission rates. Multivariable logistic regressions were performed to compare the 2 groups while accounting for significant demographic variables. Of the 24,933 patients included, 1,725 (7%) were SDD and 23,208 (93%) required a longer length of stay. The overall rate of 90-day ED visits was significantly lower for patients who were SDD compared to non-SDD (1.6% vs 4.0%, P = .004). However, when stratified based on the reason for ED visit, no single cause was significant between the 2 cohorts. The most commonly reported reasons were pain (32.1% vs 26.7%, P = .064) and other non–orthopedic-related medical issues (25.0% vs 29.5%, P = .206). Among those who presented to the ED, the readmission rate did not statistically differ (25.0% vs 23.4%, P = .131). Patients who underwent SDD were less likely to present to the ED within 90 days following their surgery compared to non-SDD. Approximately three fourths of the patients in both cohorts that visited the ED did not require readmission. Future efforts should focus on developing interventions to reduce the burden of these visits on the healthcare system. Retrospective Cohort Study.