J Knee Surg 2020; 33(01): 008-011
DOI: 10.1055/s-0038-1676066
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Accelerated Discharge following Total Knee Arthroplasty May Be Safe in a Teaching Institution

Thomas A. Novack
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Jennifer Kurowicki
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Kimona Issa
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Todd P. Pierce
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Anthony Festa
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Vincent K. McInerney
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
,
Anthony J. Scillia
1  Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey
› Author Affiliations
Further Information

Publication History

05 September 2018

15 October 2018

Publication Date:
30 November 2018 (online)

Abstract

Total knee arthroplasty (TKA) is one of the most commonly performed yet costly surgical procedures in orthopaedics. With national trends and reimbursements moving in favor of shorter hospital length-of-stay (LOS), it is important to understand the complications associated with discharging patients earlier. This is particularly more challenging in a teaching institution due to complexity and variety of layers of care. Therefore, the purpose of this study was to evaluate the 90-day postoperative outcomes among those who were discharged on postoperative day 2 (POD-2) and compare them to a cohort whom had a LOS ≥ 3 days. A retrospective review of all patients who underwent a primary TKA from at a single-teaching institution from 2015 to 2017 was performed. During this time, an accelerated discharge protocol was designed and implanted in our institution. We identified 485 patients who were then substratified into two groups: patients who were discharged on POD-2 (n = 91) with the accelerated protocol and those who were discharged ≥ 3 days (n = 394). Outcomes evaluated included (1) demographics, (2) readmission rates, (3) emergency room (ER) visits, and (4) complication rates within 90 days of TKA. The POD-2 cohort was significantly younger than patients with ≥ 3-day LOS (64 vs. 69 years; p = 0.0001). There were no differences in gender ratios between the 2-day and 3-day cohorts (women, 67 vs. 72%; p = 0.34). Readmission rates (2 vs. 5%; p = 0.31) and ER visits were similar between cohorts (9 vs. 6%; p = 0.4). Medical and surgical complication rates did not differ between the two cohorts, with an overall complication rate of 5.5% in POD-2 versus 5.6% in >3 days LOS (p = 0.97). Patients discharged on POD-2 from TKA did not demonstrate an increased risk of complications, ER visits, or readmissions within 90 days in a teaching institution. However, older patients tended to have a longer LOS.