Failed Same-Calendar-Day Discharges: Understanding the Reasons for an Inpatient Stay Following Intended Outpatient Total Joint Arthroplasty

Abstract

BackgroundThe adoption of Same-Calendar-Day discharge, or outpatient, arthroplasty has driven the evolution of care pathway protocols to optimize success rates of discharging patients home on the day of surgery. There are, however, instances where patients are unable to discharge on the same day as intended and require a stay in the hospital. This can lead to a poorer patient and provider care experience as well as incur additional costs. This study, therefore, aimed to determine the incidence of “failed” Same-Calendar-Day discharge, report the demographics of this patient population, and identify common reasons for failure of Same-Calendar-Day discharge. MethodsA retrospective review of a prospectively maintained regional database of 1,002 Same-Calendar-Day discharge hip and knee arthroplasty patients was performed. Patients not discharged on the Same-Calendar-Day were converted to an Enhanced Recovery After Surgery (ERAS) pathway. The ERAS conversion cohort (n = 59) was identified, and demographics, comorbidities, and reasons for conversion were reported. ResultsOf 1,002 patients in the database, 59 (5.9%) did not achieve Same-Calendar-Day discharge. The most common comorbidities were hypertension (52.5%), arthritis of the spine (22.0%), and depression and anxiety (18.6%). The median length of stay for these patients was 1 night. The all-cause 90-day readmission rate of this patient group was 5.1%. Difficulty mobilizing (n = 16), nausea and vomiting (n = 14), and social circumstances (n = 11) were the primary causes of patients being converted to ERAS pathways. ConclusionsSame-Calendar-Day discharge arthroplasty can be successfully achieved in the majority of the patient group, provided patients are assessed and treated under standard protocols that are adapted to the individual needs. Common hurdles encountered in Same-Calendar-Day discharge arthroplasty are mobilization, nausea and vomiting, and social circumstances.