Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?

BackgroundTotal joint arthoplasty (TJA) cost containment has been a key focus for the Centers Medicare and Medicaid Services spawning significant research programmatic change, including move toward early discharge outpatient TJA. TJA outpatients receive few, if any, medical interventions before discharge, but type quantity of provided patients who stay overnight in hospital is unknown. This study quantified nature, frequency, outcome occurring after primary TJA.Methods1725 consecutive unilateral TJAs performed between 2012 2017 by single surgeon rapid-discharge program, managed perioperative internal medicine specialist, were reviewed. Medical records examined diagnostic tests, treatments, procedures, results interventions, readmissions.Results759 discharged on postoperative day 1. Eighty-four percent (641 759) received no during their stay. Twelve (1.6%) 90 (11.9%) 29 (3.8%) procedures. Ninety-two (11 12) tests negative, 66% 100 treatments intravenous fluids oliguria or hypotension, all procedures out catheterizations urinary retention. 90-day all-cause readmission rates similar (2.5%) did not (3.3%) clinical intervention.ConclusionMost suggesting unnecessary costly hospitalization. The most common issues addressed oliguria, retention, hypotension. Protocols to prevent these conditions would facilitate TJA, improve patient safety, reduce costs.