No increase in postoperative contacts with the healthcare system following outpatient total hip and knee arthroplasty.

Background and purpose - Discharge on the day of surgery (DDOS) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) has been shown to be safe in selected patients. Concerns have been raised that discharging patients on the day of surgery (DOS) could lead to an increased burden on other parts of the healthcare system when compared with patients not discharged on the DOS (nDDOS). Therefore, we investigated whether discharging patients on the day of surgery (DOS) after THA and TKA leads to increased contacts with the primary care sector or other departments within the secondary care sector.Patients and methods - Prospective data on 261 consecutive patients scheduled for outpatient THA (n = 135) and TKA (n = 126) were collected as part of a previous cohort study. 33% of THA patients and 37% of TKA patients were discharged on the DOS. Readmissions within 3 months after surgery were recorded. Contacts with the discharging department, other departments, and primary care physicians within 3 weeks were registered.Results - No statistically significant differences were found when comparing DDOS patients and patients not discharged on the DOS (nDDOS) with regard to readmissions, physical contacts with the discharging department, and contacts with other departments as well as general practitioners. THA DDOS patients had significantly fewer contacts with the discharging department by telephone than THA nDDOS patients. TKA DDOS patients had significantly more contacts with the discharging department by telephone than TKA nDDOS patients.Interpretation - Patients discharged on the DOS following THA or TKA generally have similar postoperative contacts with the healthcare system when compared with patients not discharged on the DOS.

Are functional outcomes and early pain affected by discharge on the day of surgery following total hip and knee arthroplasty?

Background and purpose - Outpatient total knee and total hip arthroplasty (TKA and THA) has been shown to be feasible and safe in selected patients. However, little data is available on functional outcome and early pain in patients discharged on the day of surgery (DOS). We investigated patient-reported outcomes at 1 year and early pain in outpatient TKA and THA patients discharged on the day of surgery (DOS) (DDOS) compared with patients scheduled for outpatient surgery but not discharged on the DOS (nDDOS).Patients and methods - Prospective data on 261 consecutive patients scheduled for outpatient TKA (n = 126) and THA (n = 135) were collected. 37% of TKA patients and 33% of THA patients were discharged on the DOS. Pain scores at rest and activity and use of morphine were registered on postoperative days 1-7. Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were collected preoperatively and at 3 and 12 months' follow-up.Results - DDOS and nDDOS patients were similar in respect to age, sex, procedure type (TKA vs. THA), or preoperative OKS or OHS. Neither OKS nor OHS differed between groups at 3 and 12 months' follow-up. Pain at rest and activity and use of morphine did not differ between the 2 groups on days 1-7.Interpretation - In patients scheduled for outpatient TKA and THA, we found similar patient-reported outcomes both early and at 1 year in those discharged on the DOS and those who had at least 1 overnight stay.