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

Abstract

The 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 (THA) and total knee arthroplasty (TKA). This retrospective study split patients into cohorts; TJA prior to COVID-19 (pre-COVID, July 2019-December 2019) and TJA following resumption of elective surgery (post-COVID, July 2020-December 2020). Patient characteristics such as age, sex, body mass index (BMI), ASA score and pertinent comorbidities were analyzed, and length-of-stay (LOS), 30-day emergency department (ED) visit rates, readmissions and reoperations were compared. 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 (IQR 63-76) and the post-COVID group had a median age of 68 years (IQR 61-75) (P=0.024). SDD increased from 0.1% to 28.9% (P<0.001) and LOS decreased from 1.3 days to 0.89 days (P<0.001). There was no change in 30-day ED visits, readmissions, or reoperations (P=0.817, P=0.470, P=0.643 respectively). There was no difference in ED visits, readmissions, or reoperations in SDD patients. The odds of SDD were associated with age (P<0.001, OR=0.94), BMI (P=0.006, OR=0.95), male sex (P<0.001, OR=1.83), and history of tobacco use (P<0.001, OR=1.87). At our institution, the COVID-19 pandemic accelerated utilization of SDD pathways without increasing ED visits, readmissions or reoperations.