Summary

Concern about the safety of day-case proceudres for THA and TKA appear to be unfounded.

Abstract

Introduction

The optimal course of postoperative rehabilitation after total hip (THA) or knee (TKA) arthroplasty is still debated.
The current surgeon’s resistance to use day-case procedures (DCPs) concerns the potential delay in the management of these complications and the potentially higher risk of complications related to the very short stay. The objective of this study was to compare the respective risks of complications, readmission and reintervention after the DCP or fast-track procedure (FTP)

Methods

All patients operated on by two experienced joint reconstruction surgeons for unilateral primary THA or TKA between July 2016 and December 2019 were eligible. 265 cases were included.
The anesthetic, operative and post-operative procedures were standardized. The selection of FTP or DCP was done according to surgeon’s and patient’s choice. All patients were contacted after 3 months. Complications, readmissions and reinterventions were recorded.
The primary endpoint was the occurrence of a complication within 90 days after the arthroplasty. The secondary criteria were the severity of complications assessed according to the Clavien-Dindo classification, and the need for readmission and reintervention within three months after the arthroplasty.
Patients were matched in both groups with a ratio of 1:1 by a propensity score calculation using logistic regression including five factors: age, gender, body mass index (BMI), ASA score, procedure performed. The data collected were compared in the two groups by a Chi² test or Fisher's exact test and by calculation of the Odd-Ratio (OR) for qualitative data, and by a Student's t test or a Mann-Whitney test for quantitative data. All tests were performed at the 5% threshold.

Results

91 FTPs (control group) and 91 DCPs (study group) were paired. There were 72 man and 110 women, with a mean age of 67 ± 8 years, and a mean BMI of 30 ± 5 kg/m². There was no significant difference between the two groups for preoperative data. There were no lost to follow-up or missing data. The mean length of stay in the control group was 3 ± 2 days.
The complication rate was not significantly higher in the study group (15% versus 11%) (p=0.38), with an OR of 1.47 (95% confidence interval: 0.62 - 3.51). The other criteria were not significantly worse in the study group (table 1). Only the TKA procedure increased the risk of complication (p=0.018), readmission (p=0.001) and reintervention (p=0.001).

Conclusion

The hypothesis was not confirmed. The complication rate within the first 3 months was not significantly higher after DCP than after FTP in matched populations. Similarly, complication severity, readmission rates and reintervention rates within the first 3 months were not significantly higher after DCP. Concern about the safety of DCPs for THA and TKA appear to be unfounded.