Predictors of failed same day discharge after joint replacem
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Identifying predictors of failed same day discharge (SDD) is critical for patient selection. Researchers evaluated patient factors associated with failure of SDD in patients undergoing elective total joint arthroplasty (TJA) in a hospital setting.

Researchers retrospectively reviewed consecutive patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) between January 31, 2018 and February 1, 2020 by one of three fellowship-trained arthroplasty surgeons. Patient demographics, co-morbidities, and clinical data were collected. Analysis was performed to assess risk factors for failed SDD.

Results:
2615 TJA (1425 TKA, 1190 THA) were performed over the study period.
--271 were SDD (80 TKA, 191 THA). There were fewer TKA than THA (5.6% vs 16.1%). 45 patients failed SDD (16.6%). Failure rates were similar in TKA and THA (18.8%, 15.7%).
--The most common reasons for failure of SDD were hypotension (24.4%), delayed resolution of spinal (24.4%) and nausea (11.1%).
--Age over 70 years, greater than 2 self-reported allergies and preoperative narcotic use were associated with failure of SDD. Gender, BMI, ASA class, and prior TJA were not significantly associated.


In particular, success of SDD was greater than 80%. Hypotension, delayed resolution of spinal and nausea accounted for 60% of failures of SDD. Patients more than 70 years-old, those with more than 2 self-reported drug allergies, or patients who used preoperative narcotics were at high risk for failure of same day discharge after THA or TKA.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0883540321000334?dgcid=rss_sd_all
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