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
- n = 500
- Papers screened using: Study Setting, Patient Population - Age, Procedure Type, Clinical Context, Predictive Factors, Outcome Measures, Study Design, Study Focus
- n = 500 Papers screened out
- n = 460 Papers included for extraction
- n = 40
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
Patient Selection Criteria:
- Extract the specific inclusion and exclusion criteria used for patient selection:
Reasons for Same-Day Discharge Failure:
- List all documented reasons for unsuccessful same-day discharge:
Predictive Factors for Same-Day Discharge Success:
- Extract statistical predictors of same-day discharge success:
Surgical Procedure Details:
- Extract specific details about surgical procedures:
Results
Characteristics of Included Studies
| Study | Study Design | Sample Size | Setting Type | Primary Outcome Definition |
|---|---|---|---|---|
| Velichala et al., 2024 | Retrospective | 31,347 | No mention found | 30-day readmission after outpatient Total Knee Arthroplasty (TKA) |
| Murrell et al., 2023 | Retrospective, single-center | 606 | Single-center | 24-hour discharge after elective hip/knee arthroplasty |
| Keulen et al., 2020 | Retrospective | 525 | No mention found | Same-day discharge after outpatient hip/knee arthroplasty |
| 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) |
| Sher et al., 2017 | Retrospective, multi-center | 120,847 | Multi-center | Same-day discharge and post-discharge complications after TJA |
| Radtke et al., 2024 | Retrospective, single-center | 3,093 | Single-center | Failure to launch (discharge home) after scheduled same-day discharge TJA |
| Danielsen et al., 2024 | Prospective, multicentre cohort | 6,142 | Multicenter | Day-case success after Total Hip Arthroplasty (THA), TKA, Medial Unicompartmental Knee Arthroplasty (mUKA) |
| Gong et al., 2023 | Retrospective, single-center | 753 | Single-center | Reasons/risk factors for failed same-day discharge after TKA/THA |
| Kort et al., 2017 | Review | 14 studies | N/A | Patient selection criteria for outpatient joint arthroplasty |
| Jaibaji et al., 2020 | Systematic review | 6,519 | N/A | Complication/reoperation rates after outpatient arthroplasty |
Effects
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 | 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 (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 |
Clinical Characteristics
- All 11 patient factors listed above were associated with decreased same-day discharge success.
Surgical Procedure Details
- Types of arthroplasty performed: THA, TKA, mUKA
References
- James Murrell et al., 2023. Identifying Preoperative Predictors for 24-Hour Discharge After Elective Hip and Knee Arthroplasties. Cureus
- M. Keulen et al., 2020. Predictors of (Un)successful Same-Day Discharge in Selected Patients Following Outpatient Hip and Knee Arthroplasty. Journal of 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. Journal of the American Academy of Orthopaedic Surgeons