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Allergies, Preoperative Narcotic Use, and Increased Age Predict Failed Same-Day Discharge After Joint Replacement.
Lieberman, Elizabeth G; Hansen, Erik J; Clohisy, John C; Nunley, Ryan M; Lawrie, Charles M.
Affiliation
  • Lieberman EG; Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR.
  • Hansen EJ; Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC.
  • Clohisy JC; Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
  • Nunley RM; Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
  • Lawrie CM; Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
J Arthroplasty ; 36(7S): S168-S172, 2021 07.
Article in En | MEDLINE | ID: mdl-33518359
BACKGROUND: Identifying predictors of failed same-day discharge (SDD) is critical for patient selection. We evaluated patient factors associated with failure of SDD in patients undergoing elective total joint arthroplasty (TJA) in a hospital setting. METHODS: We retrospectively reviewed consecutive patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) between January 31, 2018 and February 1, 2020 by one of the 3 fellowship-trained arthroplasty surgeons. Patient demographics, comorbidities, and clinical data were collected. Analysis was performed to assess risk factors for failed SDD. RESULTS: In total, 2615 TJAs (1425 TKAs, 1190 THAs) were performed over the study period. Two hundred seventy-one (10.4%) were SDDs (80 TKAs, 191 THAs). There were fewer TKAs than THAs (5.6% vs 16.1%, P < .001). Forty-five patients failed SDD (16.6%). Failure rates were similar in TKA and THA (18.8%, 15.7%, P = .54). The most common reasons for failure of SDD were hypotension (11, 24.4%), delayed resolution of spinal anesthesia (11, 24.4%), and nausea (5, 11.1%). Age over 70 years (P = .007), greater than 2 self-reported allergies (P < .001), and preoperative narcotic use (P = .01) were associated with failure of SDD. Gender, body mass index, American Society of Anesthesiologists class, and prior TJA were not significantly associated (P > .05). CONCLUSION: Success of SDD was greater than 80%. Hypotension, delayed resolution of spinal anesthesia, and nausea accounted for 60% of failures of SDD. Patients >70 years, those with >2 self-reported drug allergies, or patients who used preoperative narcotics were at high risk for failure of SDD after THA or TKA.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arthroplasty, Replacement, Hip / Hypersensitivity Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Humans Language: En Journal: J Arthroplasty Journal subject: ORTOPEDIA Year: 2021 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Arthroplasty, Replacement, Hip / Hypersensitivity Type of study: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Humans Language: En Journal: J Arthroplasty Journal subject: ORTOPEDIA Year: 2021 Document type: Article Country of publication: United States