[Is early discharge following primary total knee arthroplasty a risk factor for the development of complications, readmissions and unscheduled consultations?]

Abstract

Introduction: total knee arthroplasty (TKA) is a surgical procedure with a growing number of indications worldwide. The trend in recent years has been to reduce hospital stay without compromising safety and quality of care. The aim of this study was to determine whether early discharge (less than 24 hours) is associated with a higher rate of complications, readmissions and unscheduled visits in patients undergoing primary knee arthroplasty.

Material and methods: we performed a sample calculation and proposed a statistical test of non-inferiority. We retrospectively studied 229 patients undergoing TKA between 2020 and 2022. Patients with primary osteoarthritis undergoing primary total knee arthroplasty with 90 days of postoperative follow-up were included. Those with revision surgeries, simultaneous bilateral surgeries, complications intraoperatively or during hospitalisation, and those unable to follow the usual postoperative protocol for medical reasons were excluded. These were divided into two groups: early discharge (less than 24 hours) and standard discharge (more than 24 hours). The occurrence of the target variables was recorded for 90 days.

Results: the analysis showed no statistically significant differences when comparing readmissions 4.1 vs 2.2% (p = 0.407), complications 11.4 vs 12% (p = 0.895) and unscheduled consultations 15.6 vs 16.5% (p = 0.853) between both groups of patients.

Conclusions: the findings suggest that the early discharge protocol in primary total knee arthroplasty is not significantly inferior to the standard and could be considered as a viable alternative in clinical practice.