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.
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 the following criteria:
- Study Setting: Investigates outpatient/day-case/ambulatory arthroplasty procedures?
- Patient Population - Age: Includes only adult patients (≥18 years)?
- Procedure Type: Examines primary (non-revision) hip, knee, shoulder, or ankle arthroplasty?
- Clinical Context: Examines planned elective procedures (not emergency or trauma-related cases)?
- Predictive Factors: Analyzes patient-related predictive factors (age, BMI, comorbidities, or social support)?
- Outcome Measures: Reports specific outcomes related to success/failure of day-case surgery (same-day discharge, unplanned overnight stays, or 30-day readmissions)?
- Study Design: Study design is either a prospective/retrospective cohort study, case-control study, RCT, or systematic review with 10 or more patients?
- Study Focus: Includes patient-related factors (not exclusively surgical technique, anesthetic protocol, or hospital/surgeon factors)?
We considered all screening questions together and made a holistic judgment about whether to screen in each paper.
Data extraction
We asked a large language model to extract specific data columns.
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 |
| Danielsen et al., 2024 | Prospective, multicentre cohort | 6,142 | Multicenter | Day-case success after Total Hip Arthroplasty (THA), TKA, mUKA | Yes |
| Gong et al., 2023 | Retrospective, single-center | 753 | Single-center | Reasons/risk factors for failed same-day discharge after TKA/THA | 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 |
Success Rates and Risk Patterns
Overall Success Rates
| 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 |
| Keulen et al., 2020 | 79% | Outpatient hip/knee arthroplasty |
| Foley et al., 2023 | 99.7% (Ambulatory Surgery Center), 66.7% (hospital) | Total Joint Arthroplasty |
Common Failure Patterns
| 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% |
Risk Stratification Models
| Study | Model/Tool | Predictive Value | Notes |
|---|---|---|---|
| Meneghini et al., 2017 | Outpatient Arthroplasty Risk Assessment (OARA) score | OR 2.0–2.7 for early discharge | More predictive than ASA/Charlson Comorbidity Index |
| Wei et al., 2021 | Artificial Neural Network (ANN) model | AUC 0.801 | Total Knee Arthroplasty |
References
- James Murrell et al., 2023. Identifying Preoperative Predictors for 24-Hour Discharge After Elective Hip and Knee Arthroplasties.
- M. Keulen et al., 2020. Predictors of (Un)successful Same-Day Discharge in Selected Patients Following Outpatient Hip and Knee Arthroplasty.
- 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.
- A. Sher et al., 2017. Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications.
- Oddrún Danielsen et al., 2024. Day-case success or why still in hospital after total hip, total knee, and medial unicompartmental knee arthroplasties?