• Jiabin Liu, Nabil Elkassabany, Jashvant Poeran, Gonzalez Della ValleAlejandroADepartment of orthopedic surgery, Hospital for Special Surgery, New York City, New York, USA., David H Kim, Daniel Maalouf, and Stavros Memtsoudis.
• Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, Weill Medical College of Cornell University, New York City, New York, USA liuji@hss.edu.
• BMJ Open. 2019 Dec 8; 9 (12): e031260.

ObjectiveTo determine if same-day discharge total knee arthroplasty (TKA) or total hip arthroplasty (THA) is not associated with increased risk of unplanned readmission and adverse outcomes within 30 days of surgery.DesignThis is a population-based observational study.SettingPatients from 708 participating institutions who underwent primary TKA or primary THA between 2011 and 2017 were divided into three groups by length of stay (LOS 0, 1 and 2-3 days). All patients with LOS>3 days were excluded from the current study. Regression analysis and propensity score matching were performed.Data SourcesAmerican College of Surgeons-National Surgical Quality Improvement Programme database.Main Outcomes And MeasuresPrimary outcomes included unplanned readmission and cardiac/pulmonary complications within 30 days of surgery.ResultsWe identified 226 481 TKA (LOS 0=3118, LOS 1=31 404, and LOS 2-3=1 91 959) and 140 557 THA patients (LOS 0=2652, LOS 1=29 617, and LOS 2-3=1 08 288). There were no differences in 30-day mortality. After adjusting for relevant covariates, LOS 0 (compared with LOS 1) was associated with higher odds of cardiac/pulmonary complications in both TKA (OR 1.95, 95% CI 1.20 to 3.16; 0.67% vs 0.37%) and THA (OR 1.96, 95% CI 1.05 to 3.64; 0.57% vs 0.26%). There were no statistical differences in unplanned readmissions between LOS 0 and LOS 1 groups in TKA (2.41% vs 2.31%) and THA (1.62% vs 2.04%).ConclusionsLOS 0 discharge after TKA and THA was associated with higher odds of cardiac/pulmonary complications compared with LOS 1 discharge. While the overall burden of complications is relatively low, until future studies can confirm or challenge our findings, a measured approach is advisable when recommending discharge of patients on the same day of surgery.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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