Weekend versus Weekday Procedures for Total Knee Arthroplasty

Tiffany Lee; David Momtaz; Youssef Khalafallah; Alexandra Mclennan; Abdullah Ghali; Philip Ghobrial; Roberto Gonzalez; Ali Seifi; Khaled Saleh

doi:10.1055/a-2555-1791

The Journal of Knee Surgery, Inhaltsverzeichnis

J Knee Surg 2025; 38(09): 477-484
DOI: 10.1055/a-2555-1791

Original Article

Weekend versus Weekday Procedures for Total Knee Arthroplasty

Authors

Tiffany Lee

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
David Momtaz

²Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
Youssef Khalafallah

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
Alexandra Mclennan

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
Abdullah Ghali

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
Philip Ghobrial

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
Roberto Gonzalez

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas
Ali Seifi

²Department of Neurosurgery, UT Health San Antonio, San Antonio, Texas
Khaled Saleh

¹Department of Orthopedics, Baylor College of Medicine, Houston, Texas

Abstract

This study compares the outcomes of elective total knee arthroplasty (TKA) on a weekday versus the weekend. Patients undergoing elective TKA from 2016 to 2020 were identified using the Healthcare Cost and Utilization Project database. Demographics and hospital-related outcomes including length of stay (LOS), total charges, pain, wound disruption, implant infection, and mortality, were collected. Perioperative outcomes were assessed from each patient's concurrent diagnoses. Multivariable analysis was performed. A total of 586,285 patients who underwent elective TKA were identified, of which 2,199 (0.37%) were performed on the weekend. Patients undergoing weekend TKA were slightly older (68.055 ± 9.882 vs. 66.699 ± 9.454, p < 0.001), and had a statistically significant predilection toward Asians, Hispanics, and Blacks (p < 0.001). No significant difference was present in gender, obesity, or preoperative conditions. Weekend TKA patients had increased odds of prolonged LOS (odds ratio [OR]: 1.154 for LOS ≥3 days, p = 0.002) and higher total charges (OR: 1.328, p < 0.001), along with higher odds of uncontrolled pain (OR: 1.257, p = 0.001) and implant infection (OR: 1.418, p = 0.004). No significant differences in wound disruption or mortality were found. Our findings indicate an association between weekend TKA and increased pain, implant infection, LOS, and cost, validating the presence of a weekend effect on TKA. Future research is needed to clarify the underlying causes of this association and feasible ways to mitigate its impact.

Keywords

total knee arthroplasty - elective arthroplasty - weekend effect - day of surgery - postoperative complications

Volltext

Referenzen

References
1 Mathew A, Fyyaz SA, Carter PR, Potluri R. The enigma of the weekend effect. J Thorac Dis 2018; 10 (01) 102-105
2 Dvorak JE, Lester ELW, Maluso PJ, Tatebe LC, Bokhari F. There is no weekend effect in the trauma patient. J Surg Res 2021; 258: 195-199
3 Honeyford K, Cecil E, Lo M, Bottle A, Aylin P. The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis. BMC Health Serv Res 2018; 18 (01) 870
4 Pauls LA, Johnson-Paben R, McGready J, Murphy JD, Pronovost PJ, Wu CL. The weekend effect in hospitalized patients: a meta-analysis. J Hosp Med 2017; 12 (09) 760-766
5 Piras GN, Baggio U, Tortorella V, Storace L, Negro F, Marinelli E. The weekend factor: the effect on healthcare quality. A medico-legal, retrospective study. Clin Ter 2024; 175 (Suppl. 02) 213-218
6 Zapf MAC, Kothari AN, Markossian T. et al. The “weekend effect” in urgent general operative procedures. Surgery 2015; 158 (02) 508-514
7 Barratt H, Turner S, Hutchings A. et al. Mixed methods evaluation of the getting it right first time programme - improvements to NHS orthopaedic care in England: study protocol. BMC Health Serv Res 2017; 17 (01) 71
8 Otero JE, Gholson JJ, Pugely AJ, Gao Y, Bedard NA, Callaghan JJ. Length of hospitalization after joint arthroplasty: does early discharge affect complications and readmission rates?. J Arthroplasty 2016; 31 (12) 2714-2725
9 Briggs W, Guevel B, McCaskie AW, McDonnell SM. Multi- and univariate analyses of the weekend effect for elective lower-limb joint replacements. Ann R Coll Surg Engl 2018; 100 (01) 42-46
10 Guo J, Ye P, Zhang Q. et al. Is there a “weekend effect” in intertrochanteric fracture surgery?. Gerontology 2022; 68 (08) 877-888
11 Ren R, Dominy C, Bueno B. et al. Weekend admission increases risk of readmissions following elective cervical spinal fusion. Neurospine 2023; 20 (01) 290-300
12 Ahsanuddin S, Snyder DJ, Huang HH, Keswani A, Poeran J, Moucha CS. Surgical scheduling impacts hospital length of stay and associated healthcare costs for patients undergoing total hip and knee arthroplasty. HSS J 2022; 18 (03) 385-392
13 Rudge G. The rise and fall of the weekend effect. J Health Serv Res Policy 2019; 24 (04) 217-218
14 Muppavarapu RC, Chaurasia AR, Schwarzkopf R, Matzkin EG, Cassidy CC, Smith EL. Total joint arthroplasty surgery: does day of surgery matter?. J Arthroplasty 2014; 29 (10) 1943-1945
15 Newman JM, Szubski CR, Barsoum WK, Higuera CA, Molloy RM, Murray TG. Day of surgery affects length of stay and charges in primary total hip and knee arthroplasty. J Arthroplasty 2017; 32 (01) 11-15
16 Boylan MR, Perfetti DC, Naziri Q, Maheshwari AV, Paulino CB, Mont MA. Is day of surgery associated with adverse clinical and economic outcomes following primary total knee arthroplasty?. J Arthroplasty 2017; 32 (08) 2339-2346
17 Malik AT, Khan S, Ali A, Mufarrih SH, Noordin S. Total knee arthroplasty: does day of surgery matter?. Clin Med Insights Arthritis Musculoskelet Disord 2018; 11: 1179544117754067
18 Lilly R, Siljander M, Koueiter DM, Verner J. Day of surgery affects length of hospitalization for patients undergoing total joint arthroplasty discharged to extended care facilities. Orthopedics 2018; 41 (02) 82-86
19 Husted H, Holm G, Jacobsen S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop 2008; 79 (02) 168-173
20 Mathijssen NMC, Verburg H, van Leeuwen CCG, Molenaar TL, Hannink G. Factors influencing length of hospital stay after primary total knee arthroplasty in a fast-track setting. Knee Surg Sports Traumatol Arthrosc 2016; 24 (08) 2692-2696
21 Jørgensen CC, Gromov K, Petersen PB, Kehlet H. Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement. Acta Orthop 2021; 92 (02) 170-175
22 Roger C, Debuyzer E, Dehl M. et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: retrospective cohort study. Orthop Traumatol Surg Res 2019; 105 (05) 949-955
23 Martino J, Peterson B, Thompson S, Cook JL, Aggarwal A. Day of week and surgery location effects on stay length and cost for total joint arthroplasty: academic versus orthopaedic-specific hospital. J Knee Surg 2018; 31 (09) 815-821
24 El Bitar YF, Illingworth KD, Scaife SL, Horberg JV, Saleh KJ. Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplasty 2015; 30 (10) 1710-1715
25 Nowak LL, Schemitsch EH. Trends in outpatient total knee arthroplasty from 2012 to 2020. J Arthroplasty 2023; 38 (6S): S21-S25
26 Edwards PK, Hadden KB, Connelly JO, Barnes CL. Effect of total joint arthroplasty surgical day of the week on length of stay and readmissions: a clinical pathway approach. J Arthroplasty 2016; 31 (12) 2726-2729
27 Al-Ashqar M, Aqil A, Phillips H. et al. There is no 'weekend effect' in elective orthopaedic surgery. Ann R Coll Surg Engl 2018; 100 (07) 551-555
28 Higgins M, Nightingale J, Sehat K. Is there a 'weekend effect' in elective lower limb arthroplasty?. Ann R Coll Surg Engl 2021; 103 (02) 110-113
29 Hunt LP, Blom A, Wilkinson JM. An analysis of 30-day mortality after weekend versus weekday elective joint arthroplasty in England and Wales: a cohort study using the National Joint Registry Dataset. Bone Joint J 2017; 99-B (12) 1618-1628
30 7-day NHS services: a factsheet. GOV.UK. Accessed March 26, 2023 at: https://www.gov.uk/government/publications/7-day-nhs-services-a-factsheet/7-day-nhs-services-a-factsheet
31 Unsocial hours payments | NHS Employers. Accessed January 18, 2025 at: https://www.nhsemployers.org/articles/unsocial-hours-payments
32 Deighton AJ, Davies C, Bourantas C. et al. Investigating consultant-led virtual review as a model for implementing 7-day cardiology services in UK clinical practice. Future Healthc J 2021; 8 (03) e666-e670
33 Ham C. Money can't buy you satisfaction. BMJ 2005; 330 (7491): 597-599
34 Duvald I, Moellekaer A, Boysen MA, Vest-Hansen B. Linking the severity of illness and the weekend effect: a cohort study examining emergency department visits. Scand J Trauma Resusc Emerg Med 2018; 26 (01) 72
35 Chen YF, Armoiry X, Higenbottam C. et al. Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis. BMJ Open 2019; 9 (06) e025764
36 Becker DJ. Do hospitals provide lower quality care on weekends?. Health Serv Res 2007; 42 (04) 1589-1612
37 Hughes K, Kuffner L, Dean B. Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty. Physiother Can 1993; 45 (04) 245-249
38 Haas R, Sarkies M, Bowles KA, O'Brien L, Haines T. Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models. Osteoarthritis Cartilage 2016; 24 (10) 1667-1681
39 Maidment ZL, Hordacre BG, Barr CJ. Effect of weekend physiotherapy provision on physiotherapy and hospital length of stay after total knee and total hip replacement. Aust Health Rev 2014; 38 (03) 265-270
40 Xiao Y, Jones A, Zhang BB. et al. Team consistency and occurrences of prolonged operative time, prolonged hospital stay, and hospital readmission: a retrospective analysis. World J Surg 2015; 39 (04) 890-896
41 Hauck K, Zhao X. How dangerous is a day in hospital? A model of adverse events and length of stay for medical inpatients. Med Care 2011; 49 (12) 1068-1075
42 Guerra ML, Singh PJ, Taylor NF. Early mobilization of patients who have had a hip or knee joint replacement reduces length of stay in hospital: a systematic review. Clin Rehabil 2015; 29 (09) 844-854
43 Reilly KA, Beard DJ, Barker KL, Dodd C, Price AJ, Murray DW. Efficacy of an accelerated recovery protocol for Oxford unicompartmental knee arthroplasty–a randomised controlled trial. Knee 2005; 12 (05) 351-357
44 Rathi P, Coleman S, Durbin-Johnson B, Giordani M, Pereira G, Di Cesare PE. Effect of day of the week of primary total hip arthroplasty on length of stay at a university-based teaching medical center. Am J Orthop 2014; 43 (12) E299-E303