Implementation and early results of same-day hip and knee replacement in a public hospital without prior same-day surgical experience, a feasibility study

Abstract

Background

Hip and knee replacements are increasingly performed as same-day surgery (SDS). However, the feasibility of SDS pathways in departments without prior experience is unknown. We report on the implementation process, feasibility and early results of implementing a SDS protocol in a department without prior experience with same-day hip and knee replacement.

Methods

The study design was based on Bowens feasibility study framework on implementation processes. Data were collected prospectively through patient reported questionnaires and medical records during, and from the local Department of Digitalisation and Analytics after implementation. Outcome data included discharge on day of surgery, 30-days primary-care contacts, 90-days readmissions and patient satisfaction.

Results

Implementation was initiated as a dedicated fellowship from September 2023 to October 2024. Patients were admitted and discharged through a dedicated day-surgical department with transfer to the regular ward in case of admission. The first SDS patient underwent surgery the 4th of September 2023. By October 2024, 150 of 713 operated patients (21.0% CI:18.2–24.2) had SDS. Of these, same-day discharge was achieved in 125 (83.3% CI:76.6–88.5) patients of which 6 (4.0% CI:0.9–7.1) were readmitted within 90-days. From October 2024 to October 2025, 178 of 800 patients were planned for SDS (22.3% CI:19.5–25.3), of which 131 (73.6% CI: 66.7–80.1) achieved same-day discharge despite less restrictive inclusion criteria.

Conclusion

Implementation of a protocolled SDS framework was feasible within 1 year despite no prior SDS experience. SDS utilisation and success remained stable the 12 following months, confirming adaptation into standard of care.