Feasibility of outpatient total hip and knee arthroplasty in unselected patients

Figures & data

Table 1. Criteria for discharge on the day of surgery (DOS)

DOS discharge criteria

•< 500 mL intraoperative blood loss

•Back in patient ward before 3 p.m.

•Received instruction from physiotherapist and is safely mobilized

•No clinical symptoms of anemia^a

•Pain <3 while resting, < 5 during mobilization.

•Spontaneous urination

•Postoperative radiograph approved

•Relative or friend with patient for >24 hours

•Motivated and accepts same-day discharge

•Standard discharge criteria fulfilled^b

•Can be discharged before 8 p.m.

a Paleness, dizziness during mobilization, and fatigue were considered to be clinical signs of anemia.

b Standard discharge criteria were: ability to get dressed independently, ability to get in and out of bed, ability to sit and rise from a chair/toilet, independence in personal care, mobilization with walker/crutches, and ability to walk >70 m with crutches.

Figure 1. Flow chart for inclusion of TKA patients for same-day (SD) discharge. ^a Language problems (1), low compliance (4), living at a nursing home (1), and unknown (1).

Figure 2. Flow chart for inclusion of THA patients for same-day (SD) discharge. ^a Chronic pain (1), cancer (1), low compliance (3), and unknown (2).

Table 4. Logistic regression analysis. Odd ratios for not being discharged on day of surgery. The lower limit and upper limit for RR estimates are also presented

	OR (95% CI)	p-value	RR lower limit	RR upper limit
Sex, male	0.43 (0.22–0.81)	0.009	0.4	0.7
Age >75 years	2.6 (0.89–7.7)	0.08	1.0	1.8
BMI >35	3.3 (0.87–12.6)	0.08	1.0	2.1
THA	0.79 (0.41–1.5)	0.5	0.6	0.7
ASA 2	0.92 (0.49–1.8)	0.8	0.6	0.7
Second in the operating room	2.4 (1.2–4.8)	0.01	1.0	1.7
Distance to home >50 km	0.84 (0.54–1.3)	0.4	0.5	0.7

Table 5. Probability of being discharged on the day of surgery (DOS) for a reference patient^a and change in probability of being discharged on DOS for a single changed parameter from the reference patient

Parameter	DOS discharge probability (%) (95% confidence interval)
Reference patient^a	68 (45–84)
Female	47 (26–70)
Age >75	39 (12–74)
BMI >35	45 (18–75)
TKA	62 (41–80)
ASA 1	66 (43–83)
Second in the operating room	47 (24–70)
Distance to home <10 km	60 (41–76)
Distance to home 10–50 km	64 (46–78)

a Reference patient with the highest probability for being discharged on DOS: male, < 75 years old, BMI <35, ASA 2, receiving THA surgery as first in the operating room, living >50 km from the hospital.

Table 6. Probability of being discharged on the day of surgery (DOS) for different combinations of significant (gender) and near-significant (age and BMI) patient-related factors

	Combination of patient-related factors
Sex	Age, years	BMI	Probability of discharge on DOS
Male	< 75	< 35	68%
Male	< 75	> 35	39%
Male	> 75	< 35	45%
Male	> 75	> 35	20%
Female	< 75	< 35	47%
Female	< 75	> 35	21%
Female	> 75	< 35	25%
Female	> 75	> 35	9%