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.

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:

• Study Setting: Does the study investigate outpatient/day-case/ambulatory arthroplasty procedures?
• Patient Population - Age: Does the study include only adult patients (≥18 years)?
• Procedure Type: Does the study examine primary (non-revision) hip, knee, shoulder, or ankle arthroplasty?
• Clinical Context: Does the study examine planned elective procedures (not emergency or trauma-related cases)?
• Predictive Factors: Does the study analyze patient-related predictive factors (such as age, BMI, comorbidities, or social support)?
• Outcome Measures: Does the study report specific outcomes related to success/failure of day-case surgery (such as same-day discharge, unplanned overnight stays, or 30-day readmissions)?
• Study Design: Is the study design either a prospective/retrospective cohort study, case-control study, RCT, or systematic review with 10 or more patients?
• Study Focus: Does the study include patient-related factors (not exclusively focusing on surgical technique, anesthetic protocol, or hospital/surgeon factors)?

We considered all screening questions together and made a holistic judgement about whether to screen in each paper.

Data extraction

• Study Design: Identify the specific type of study design used:

• Specify whether it is retrospective, prospective, or cross-sectional

• Note if it is a single-center or multi-center study

• If multiple study designs are present, list all and indicate which is the primary design

Look in the methods section for explicit statements about study design. If the design is not clearly stated, carefully review the methodology description to determine the most appropriate classification. If uncertain, note “unclear” and provide a brief explanation.

• Patient Selection Criteria: Extract the specific inclusion and exclusion criteria used for patient selection:

• List all explicit inclusion criteria (e.g., age range, type of arthroplasty, patient health status)

• List all explicit exclusion criteria

• Note any specific screening or eligibility assessment methods

Locate this information in the methods section. If criteria are not fully detailed, extract all available information. If partial or no criteria are provided, note “insufficient information” and quote any relevant text describing patient selection.

• Patient Demographic and Clinical Factors: Extract key patient characteristics that could predict day-case arthroplasty success:

• Age (mean and range)

• Gender distribution

• Body Mass Index (if reported)

• Comorbidities (e.g., Charnley class, ASA score)

• Previous joint surgeries

• Preoperative medication use

Locate this information in the patient characteristics section or baseline demographics table. If data is presented in multiple formats, prioritize mean/median values with standard deviation or confidence intervals. If specific factors are not fully reported, note which specific characteristics are missing.

• Reasons for Same-Day Discharge Failure: List all documented reasons for unsuccessful same-day discharge:

• Rank reasons by frequency if provided

• Extract specific percentages or proportions for each reason

• Include both clinical and procedural reasons for failure

Search results and discussion sections for explicit statements about discharge failure reasons. If reasons are not comprehensively listed, extract all available information. Ensure to differentiate between reasons for different types of arthroplasty (THA, TKA, mUKA) if such distinctions are made.

• Predictive Factors for Same-Day Discharge Success: Extract statistical predictors of same-day discharge success:

• List all statistically significant factors

• Record odds ratios, confidence intervals, and p-values

• Distinguish between factors that increase or decrease likelihood of successful discharge

Prioritize information from multivariable regression analyses in the results section. If multiple analyses are present, extract results from the most comprehensive analysis. If predictive factors are not statistically analyzed, note “no statistical analysis of predictive factors” and extract any descriptive observations.

• Surgical Procedure Details: Extract specific details about surgical procedures:

• Types of arthroplasty performed (THA, TKA, mUKA)

• Surgical timing (e.g., surgery start time)

• Anesthesia type

• Surgical duration

Locate this information in methods and results sections. If details vary between procedure types, create separate entries for each. If specific details are inconsistently or partially reported, extract all available information and note any limitations.

Results

Characteristics of Included Studies

Effects

Patient Demographics

Key findings from these studies:

• Older age: Supported by more than 20 studies as decreasing the likelihood of same-day discharge success.
• Female sex: Supported by more than 15 studies as decreasing same-day discharge success.
• Higher body mass index: Supported by more than 10 studies as decreasing same-day discharge success.
• Non-white race: Supported by more than 5 studies as decreasing same-day discharge success.
• Non-married marital status: Supported by 2 studies as decreasing same-day discharge success.
• Younger age (<40): Reported in 2 studies as decreasing same-day discharge success, but this finding was inconsistent.

Clinical Characteristics

Summary of findings:

• All 11 patient factors listed above were associated with decreased same-day discharge success.
• The most frequently supported factors were higher ASA class (15+ studies), greater comorbidity burden (10+ studies), hypertension (8+ studies), diabetes (7+ studies), and cardiovascular disease (6+ studies).
• All reported effect sizes and statistical significance values indicated a negative impact on same-day discharge success for these factors.
• We did not find mention of any factors in this table that were associated with increased same-day discharge success, nor did we find inconsistent or positive associations.

Perioperative Factors

Key findings:

• Longer surgical or anesthesia duration: Most frequently supported, with more than 10 studies reporting a negative association with same-day discharge success.
• Later surgical start time: Reported in more than 8 studies as decreasing same-day discharge success.
• General anesthesia (compared to spinal): Associated with decreased same-day discharge success in more than 3 studies.
• Not ambulating on the day of surgery: Reported in more than 3 studies as decreasing same-day discharge success.
• Higher intraoperative blood loss: Associated with decreased same-day discharge success in more than 2 studies.
• Higher postoperative pain: Reported in more than 2 studies as decreasing same-day discharge success.
• All reported effect sizes and statistical significance values indicated a negative impact on same-day discharge success for these factors.

Success Rates and Risk Patterns

Overall Success Rates

Common Failure Patterns

Risk Stratification Models

References

1. James Murrell et al., (2023). Identifying Preoperative Predictors for 24-Hour Discharge After Elective Hip and Knee Arthroplasties. Cureus
2. M. Keulen et al., (2020). Predictors of (Un)successful Same-Day Discharge in Selected Patients Following Outpatient Hip and Knee Arthroplasty. Journal of Arthroplasty
3. David P Foley et al., (2023). Predictors of Failure to Achieve Planned Same-Day Discharge after Primary Total Joint Arthroplasty: a Multivariable Analysis of Perioperative Risk Factors. Journal of the American Academy of Orthopaedic Surgeons
4. A. Sher et al., (2017). Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications. Journal of Arthroplasty
5. Logan Radtke et al., (2024). Outpatient Total Joint Arthroplasty at a High-Volume Academic Center: An Analysis of Failure to Launch. Journal of Arthroplasty
6. Oddrún Danielsen et al., (2024). Day-case success or why still in hospital after total hip, total knee, and medial unicompartmental knee arthroplasties?. Bone & Joint Open
7. Matthew F. Gong et al., (2023). Reasons and Risk Factors for Failed Same-Day Discharge after Total Joint Arthroplasty. Journal of Arthroplasty
8. N. Kort et al., (2017). Patient selection criteria for outpatient joint arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy
9. M. Jaibaji et al., (2020). Is Outpatient Arthroplasty Safe? A Systematic Review. Journal of Arthroplasty
10. Elizabeth G Lieberman et al., (2021). Allergies, Preoperative Narcotic Use, and Increased Age Predict Failed Same-Day Discharge After Joint Replacement. Journal of Arthroplasty
11. T. Bayoumi et al., (2022). Successful same-day discharge in 88% of patients after unicompartmental knee arthroplasty: a systematic review and meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy
12. Ehab M. Nazzal et al., (2025). Predictors of Failing Same-Day Discharge after Shoulder Arthroplasty: Developing a Model to Improve Outcomes and Reduce Healthcare Cost. Journal of shoulder and elbow surgery
13. Ramish Sumbal et al., (2024). Reasons and Risk Factors for Same-Day Discharge Following Total Joint Arthroplasty: A Systematic Review. Arthroplasty Today
14. S. Lalonde et al., (2019). Short stay total joint arthroplasty program: patient factors predicting readmission. Canadian journal of surgery. Journal canadien de chirurgie
15. R. Meneghini et al., (2017). Safe Selection of Outpatient Joint Arthroplasty Patients With Medical Risk Stratification: the "Outpatient Arthroplasty Risk Assessment Score". Journal of Arthroplasty
16. J. Fraser et al., (2018). Identifying Reasons for Failed Same-Day Discharge Following Primary Total Hip Arthroplasty. Journal of Arthroplasty
17. Justin J. Turcotte et al., (2021). Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty. Arthroplasty Today
18. Vivek Singh et al., (2021). Failure to Meet Same-Day Discharge is Not a Predictor of Adverse Outcomes. Archives of Orthopaedic and Trauma Surgery
19. P. Courtney et al., (2017). Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. Journal of Arthroplasty
20. Kelsey Girbino et al., (2020). Understanding the Main Predictors of Length of Stay After Total Hip Arthroplasty: Patient-Related or Procedure-Related Risk Factors?. Journal of Arthroplasty
21. Brian Darrith et al., (2019). Inpatient Versus Outpatient Arthroplasty: A Single-Surgeon, Matched Cohort Analysis of 90-Day Complications. Journal of Arthroplasty
22. B. Burton et al., (2020). Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study. Korean Journal of Anesthesiology
23. J. French et al., (2024). Day-case knee and hip replacement. The Bone & Joint Journal
24. D. Crawford et al., (2022). Is an "Outpatient Arthroplasty Risk Assessment Score" needed for predicting safe selection of outpatient arthroplasty candidates?. Journal of Arthroplasty
25. Udai S. Sibia et al., (2016). Predictors of Hospital Length of Stay in an Enhanced Recovery After Surgery Program for Primary Total Hip Arthroplasty. Journal of Arthroplasty
26. Udai S. Sibia et al., (2017). Who Is Not a Candidate for a 1-Day Hospital-Based Total Knee Arthroplasty?. Journal of Arthroplasty
27. Neng-Ping Gao et al., (2022). Comparison of day-case versus inpatient uni-compartmental knee replacement. Musculoskeletal Care
28. J. W. Robison et al., (2024). The Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty. Journal of Arthroplasty
29. Kelvin Kim et al., (2017). Primary Total Hip Arthroplasty With Same-Day Discharge: Who Failed and Why. Orthopedics
30. Chapman Wei et al., (2021). Artificial neural network prediction of same-day discharge following primary total knee arthroplasty based on preoperative and intraoperative variables. The Bone & Joint Journal
31. Jesse E. Otero et al., (2016). Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?. Journal of Arthroplasty
32. Y. Bemelmans et al., (2021). Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis. Archives of Orthopaedic and Trauma Surgery
33. A. Gazendam et al., (2022). Causes and predictors of failed same-day home discharge following primary hip and knee total joint arthroplasty: a Canadian perspective. HIP International
34. Patawut Bovonratwet et al., (2020). Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Knee Arthroplasty: A Review of 3015 Cases. Journal of Arthroplasty
35. D. Vermaak et al., (2024). Failed Same-Calendar-Day Discharges: Understanding the Reasons for an Inpatient Stay Following Intended Outpatient Total Joint Arthroplasty. Journal of Arthroplasty
36. Maya Y. Matsumoto et al., (2020). Barriers to achieving same day discharge following unilateral unicompartmental knee arthroplasty. Knee (Oxford)
37. Christopher Del Balso et al., (2022). Factors Predictive of Early Complications Following Total Ankle Arthroplasty. Foot & Ankle Orthopaedics
38. Daniel E. Goltz et al., (2021). Appropriate Patient Selection for Outpatient Shoulder Arthroplasty: A Risk Prediction Tool. Journal of shoulder and elbow surgery
39. Gérald Delfosse et al., (2024). Is outpatient joint arthroplasty safe in a high volume academic centre? A retrospective monocentric study using an institutional pathway. International Orthopaedics
40. S. Velichala et al., (2024). Risk Factors and Incidence of 30-Day Readmission following Outpatient Total Knee Arthroplasty. Journal of Arthroplasty

Report

Version: August 7, 2025 11:20 AM
Status: Gather sources
Details: 500 sources found