Day-case hip and knee arthroplasty does not increase healthcare system contacts: a prospective multicenter study in a public healthcare setting

Abstract

Background and purpose — Discharge on day of surgery after hip or knee arthroplasty is increasing, but whether this leads to an increase in the overall number of post-discharge healthcare system contacts is unknown. We aimed to investigate whether day-case surgery leads to increased patient-reported healthcare system contacts compared with non-day-case surgery within the first 30 days postoperatively. Methods — We performed a prospective multicenter study at seven fast-track centers from September 2022 to August 2023. Candidates for primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) were evaluated for day-case eligibility using pre-defined criteria. Patients received a survey 30 days postoperatively regarding any healthcare system contacts related to surgery. Planned healthcare visits were excluded. We used day-case eligible patients not discharged on day of surgery (inpatients) as control group. Results — Of 2,278 day-case eligible patients, 2,073 (91%) completed the survey, including 1,146 day-case patients (55%) and 927 inpatients (45%). The overall rate of health-care system contacts was 49% (95% confidence interval [CI] 45–51) in day-case patients compared with 52% (CI 49–56) in inpatients. Specific contacts included visits to a general practitioner (GP) or out-of-hours medical clinic (25% [CI 22–27] vs 32% [CI 29–35]), the emergency department (ED) (6% [CI 4–7] vs 7% [CI 5–8]), and outpatient clinics or wards (35% [CI 33–38] vs 35% [CI 32–38]). The most common reasons for all types of healthcare contacts were wound problems, prescription renewals, and pain management. Conclusion — Day-case hip and knee arthroplasties was not associated with increased healthcare system contacts within the first 30 days postoperatively.