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. Papers identified with Elicit search: 500 Papers screened using: Study Setting, Patient Population - Age, Procedure Type, Clinical Context, Predictive Factors, Outcome Measures, Study Design, Study Focus. Papers screened out: 460. Papers included for extraction: 40.

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, single-center	466	Single-center	Failure to achieve planned same-day discharge after Total Joint Arthroplasty (TJA)	No
Sher et al., 2017	Retrospective, multi-center	120,847	Multi-center	Same-day discharge and post-discharge complications after TJA	No
Danielsen et al., 2024	Prospective, multicentre cohort	6,142	Multicenter	Day-case success after Total Hip Arthroplasty (THA), TKA, Medial Unicompartmental Knee Arthroplasty (mUKA)	Yes

Patient Demographics

Factor	Effect Size Range	Direction of Effect	Number of Supporting Studies
Age (older)	Odds Ratio (OR) 1.01–4.16, Relative Risk (RR) 1.44, OR 0.935 (inverse)	Decreases same-day discharge success	20+
Female sex	OR 1.63–4.22, RR 2.76	Decreases same-day discharge success	15+
Higher body mass index	OR 1.06, OR 0.491 (inverse)	Decreases same-day discharge success	10+
Non-white race	OR 1.31–2.19, OR 0.456 (inverse)	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

Reasons for Same-Day Discharge Failure

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

Predictive Factors for Same-Day Discharge Success

Factor	Effect Size/Statistical Significance	Direction of Effect	Number of Supporting Studies
ASA class III/IV	OR 1.42–3.9, OR 0.378 (inverse)	Decreases same-day discharge success	15+
Comorbidity burden (≥3)	OR 0.507 (inverse), p<0.001	Decreases same-day discharge success	10+
Hypertension	OR 1.11–2.5, RR 2.5	Decreases same-day discharge success	8+
Diabetes	OR 1.25–4.06	Decreases same-day discharge success	7+
Higher postoperative pain	OR 1.93–5.85	Decreases same-day discharge success	2+

Success Rates and Risk Patterns

Study	Same-Day Discharge Success Rate	Notes
Velichala et al., 2024	98.14% (1.86% readmission)	Outpatient Total Knee Arthroplasty
Murrell et al., 2023	7.4% (<24h discharge)	Elective hip/knee arthroplasty