Elicit: Predicting Day-Case Arthroplasty Outcomes

Predicting Day-Case Arthroplasty Outcomes

Which patient factors best predict success/failure of day-case arthroplasty?

Increased age, female sex (OR 1.63-4.22), high ASA classification, and multiple comorbidities (OR up to 3.9) are the primary predictors of day-case arthroplasty failure.

Abstract

Day‐case arthroplasty outcomes are influenced by clear patient factors. Studies report that increased age—which in over 20 analyses shows odds ratios from 1.01 to 4.16—and female sex—with odds ratios from 1.63 to 4.22 in more than 15 investigations—predict lower same‐day discharge success. A higher body mass index (supported in 10+ studies) and non‐white race (noted in 5+ studies) similarly relate to reduced success. In addition, clinical indicators such as an ASA classification of III or IV and a comorbidity burden of three or more conditions consistently predict failure, with odds ratios up to 3.9 and highly significant p‐values. Other conditions, including hypertension, diabetes, cardiovascular disease, and chronic obstructive pulmonary disease, are also cited as contributing to poor day‐case outcomes. Although a couple of studies flag younger age (<40) as a potential risk factor, this finding remains inconsistent.

Methods

We analyzed 40 sources from an initial pool of 500, using 8 screening criteria. Each paper was reviewed for 6 key aspects that mattered most to the research question. More on methods

Papers identified with Elicit search

Papers screened using:

Papers screened out

Papers included for extraction

Paper search

Using your research question “Which patient factors best predict success/failure of day-case arthroplasty?”, we searched across over 126 million academic papers from the Semantic Scholar corpus. We retrieved the 500 papers most relevant to the query.

Screening

We screened in sources based on their abstracts that met these criteria:

Data extraction

Results

Characteristics of Included Studies

Study Study Design Sample Size Setting Type Primary Outcome Definition Full text retrieved
Velichala et al., 2024 Retrospective 31,347 No mention found 30-day readmission after outpatient Total Knee Arthroplasty (TKA) No
Murrell et al., 2023 Retrospective, single-center 606 Single-center 24-hour discharge after elective hip/knee arthroplasty Yes
Keulen et al., 2020 Retrospective 525 No mention found Same-day discharge after outpatient hip/knee arthroplasty No
Foley et al., 2023 Retrospective analysis of prospectively collected data 466 Single-center Failure to achieve planned same-day discharge after TJA No
Sher et al., 2017 Retrospective, multi-center 120,847 Multi-center Same-day discharge and post-discharge complications after TJA No
Radtke et al., 2024 Retrospective, single-center 3,093 Single-center Failure to launch (discharge home) after scheduled same-day TJA No
Danielsen et al., 2024 Prospective, multicentre cohort 6,142 Multicenter Day-case success after THA, TKA, mUKA Yes
Gong et al., 2023 Retrospective, single-center 753 Single-center Reasons/risk factors for failed same-day discharge No
Kort et al., 2017 Review 14 studies N/A Patient selection criteria for outpatient joint arthroplasty No
Jaibaji et al., 2020 Systematic review 6,519 N/A Complication/reoperation rates after outpatient arthroplasty No

Patient Demographics

Factor Effect Size Range Direction of Effect Number of Supporting Studies
Age (older) OR 1.01–4.16, RR 1.44, OR 0.935 Decreases same-day discharge success 20+
Female sex OR 1.63–4.22, RR 2.76 Decreases same-day discharge success 15+
Body Mass Index (higher) OR 1.06, OR 0.491 Decreases same-day discharge success 10+
Non-white race OR 1.31–2.19, OR 0.456 Decreases same-day discharge success 5+
Marital status (non-married) p=0.007 Decreases same-day discharge success 2
Younger age (<40) Increased risk in some studies Decreases same-day discharge success (inconsistently) 2

Common Failure Patterns

Study Most Common Reasons for Failure Frequency/Proportion
Danielsen et al., 2024 Mobilization issues, prolonged spinal anesthesia, PONV 9–14% by reason
Gong et al., 2023 Failure to clear Physical Therapy, hypotension, urinary retention 33%, 20.5%, 16.9%

References