A comprehensive report on same-day discharge (SDD) following total hip arthroplasty (THA): a multicentre database analysis

Abstract

Introduction:

Same-day discharge (SDD) has gained increasing importance in orthopaedic surgery, particularly for hip and knee procedures. Despite initial concerns about the lack of extended hospital care, growing evidence demonstrates its benefits, including reduced in-hospital infections and significant financial and psychosocial advantages for patients and healthcare systems. This study examines the adoption and outcomes of SDD in total hip arthroplasty (THA).

Method:

A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2016 to 2021 was conducted to identify trends, predictors, and outcomes of SDD in THA.

Results:

In this study, a multicentre database analysis was performed on 235,393 patients, including 25,388 who were discharged on the same day following total hip arthroplasty. Patients undergoing same-day discharge THA were generally younger, with females comprising 48.3% of SDD cases compared to 55.6% in hospitalised patients. Operative times were shorter for SDD patients (83.9 minutes vs. 92.3 minutes). Postoperatively, SDD patients experienced significantly lower rates of 30-day readmissions (1.7% vs. 3.5%), procedure-related readmissions (1.0% vs. 2.1%), reoperations (1.1% vs. 1.9%), and mortality (0.02% vs. 0.04%). Predictors of unplanned readmissions in the SDD group included age >65 years (OR 2.0), hypertension (OR 1.6), chronic steroid use (OR 2.2), and severe COPD (OR 2.0), while gender, emergent surgery indication, and smoking were not significant predictors. The adoption of SDD increased markedly, rising from 1.5% in 2016 to 25.6% in 2021.

Conclusions:

Same-day discharge is a safe and effective option for appropriately selected THA patients, offering reduced readmission and reoperation rates, shorter operative times, and increased healthcare efficiency. This trend highlights a paradigm shift in perioperative care, improving patient outcomes and satisfaction.