Observational studyArchives of orthopaedic and trauma surgery2025
Safety of same-day discharge knee arthroplasty surgery: a retrospective analysis of observational data from the hospital episode statistics dataset for England.
Observational study in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
3 authors.
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Abstract
introductionSame-day discharge total knee arthroplasty (TKA), although still only performed regularly in a few hospital trusts in England, is becoming more common. However, evidence is needed to show that same-day discharge TKA is safe. We aimed to use a nationwide administrative data source to investigate the safety of same-day discharge TKA. MATERIALS AND
methodsWe extracted data from the Hospital Episodes Statistics database for the six years from 1st April 2017 to 31st March 2023. Patients undergoing primary elective TKA aged ≥ 17 years were included. The primary outcome was emergency readmission within 30 days of surgery. Average treatment effect on the treated (ATET) propensity score matching was used to compare outcomes for those operated on as same-day discharge and those with an overnight stay after adjusting for covariates.
resultsData was available for 398,771 patients, of whom 3,718 (0.9%) were discharge on the same day that they were admitted. Rates of same-day discharge increased from 0.5% in 2017/18 to 1.6% in 2022/23. There was a significantly increased odds of all-cause 30-day readmission in same-day discharge patients across the entire six years (ATET 0.018, 95% confidence interval 0.011 to 0.025) but not for 2022/23 (ATET 0.009, 95% confidence interval (CI) -0.001 to 0.020). Complication rates (identified during index stay or 30-day emergency readmission) were significantly lower with same-day discharge across the six years (ATET - 0.008, 95% CI -0.012 to -0.003) and for 2022/23 only (ATET - 0.015, 95% CI -0.022 to -0.008). One year mortality rates (2022/23 data excluded) were not significantly different between the two groups (ATET 0.001, 95% CI -0.002 to 0.003). Comparing trusts with > 5% and 0% same-day discharge rates for 2022/23 outcomes were either no different or better in trust with a SDD rate > 5%.
conclusionsSame-day discharge TKA is safe and outcomes have improved as the practice has become more common. Same-day discharge TKA may help to improve patient outcomes and increase the efficiency of the procedure.
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