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.
Screening Criteria:
- Study Setting: Outpatient/day-case/ambulatory arthroplasty procedures
- Patient Population - Age: Adult patients (≥18 years)
- Procedure Type: Primary (non-revision) hip, knee, shoulder, or ankle arthroplasty
- Clinical Context: Planned elective procedures (not emergency)
- Predictive Factors: Analyze patient-related predictive factors (age, BMI, comorbidities)
- Outcome Measures: Report specific outcomes related to success/failure of day-case surgery
- Study Design: Prospective/retrospective cohort, case-control, RCT, or systematic review with 10 or more patients
- Study Focus: Include patient-related factors
Results
Characteristics of Included Studies
Study Design:
- 30 retrospective studies
- 4 prospective studies
- 5 systematic reviews
Setting Type:
- 17 single-center studies
- 10 multi-center studies
Sample Size:
- 1 study with <100 participants
- 10 studies with 100–500 participants
- 15 studies with >10,000 participants
Primary Outcome Category:
- 25 studies focused on same-day discharge (SDD)
- 11 studies focused on complications or readmission
Patient Demographics
| Factor | Odds Ratio/Effect Size | Direction of Effect | Number of Studies Supporting |
|---|---|---|---|
| Age (older) | OR 1.01–4.16 | Decreases same-day discharge success | 20+ |
| Female sex | OR 1.63–4.22 | Decreases same-day discharge success | 15+ |
| Body Mass Index (higher) | OR 1.06 | Decreases same-day discharge success | 10+ |
| Non-white race | OR 1.31–2.19 | Decreases same-day discharge success | 5+ |
| Marital status (non-married) | p=0.007 | Decreases same-day discharge success | 2 |
| Younger age (<40) | Inconsistent studies | Decreases same-day discharge success | 2 |
Common Failure Patterns
| Study | Most Common Reasons for Failure | Frequency/Proportion |
|---|---|---|
| Danielsen et al., 2024 | Mobilization issues, prolonged spinal anesthesia | 9–14% by reason |
| Gong et al., 2023 | Failure to clear Physical Therapy, hypotension | 33%, 20.5%, 16.9% |
| Bayoumi et al., 2022 | Inability to mobilize, pain, nausea/vomiting | 34%, 8%, 11% |
Risk Stratification Models
| Study | Model/Tool | Predictive Value |
|---|---|---|
| Meneghini et al., 2017 | Outpatient Arthroplasty Risk Assessment | OR 2.0–2.7 for early discharge |
| Goltz et al., 2021 | 13-variable model | AUC 0.762 |
References
- Velichala et al., 2024
- Murrell et al., 2023
- Keulen et al., 2020
- Foley et al., 2023
- Sher et al., 2017
- Radtke et al., 2024
- Danielsen et al., 2024
- Gong et al., 2023
- Kort et al., 2017
- Jaibaji et al., 2020