Jul 2026· Journal of Arthroplasty· 0 citations· 19 references
Medicine
TL;DR
While SDD after primary THA is associated with low overall readmission rates, smoking and advanced age confer disproportionately greater readmission risk when same-day discharge is pursued, suggesting that smoking status and age may warrant additional attention during preoperative counseling and individualized same-day discharge decision-making.
Abstract
INTRODUCTION
Same-day discharge (SDD) following primary total hip arthroplasty (THA) is increasingly utilized and has been shown to be safe in appropriately selected patients. However, limited data compare whether specific patient risk factors for postoperative readmission exert different magnitudes of influence in the SDD versus in the non-same-day discharge (NSDD) cohorts. Identifying risk factors that disproportionately affect SDD patients may refine SDD selection criteria and improve postoperative safety.:
Methods
This retrospective cohort study evaluated 11,245 patients who underwent primary elective THA at a single institution between 2017 and 2024. Patients were grouped by discharge timing into SDD (n = 2,318) and NSDD (n = 8,927). The primary outcome was orthopaedic-related hospital readmission within 90 days. Multivariable logistic regression models were constructed separately for SDD and NSDD cohorts to identify independent predictors of readmission. Adjusted odds ratios were compared between cohorts using z-tests to assess differences in effect magnitude. A sub-analysis was performed among cases by high-volume surgeons (≥ 100 THAs/year).
Results
The SDD patients had a significantly lower 90-day readmission rate compared with NSDD patients (0.8 versus 2.1%, P < 0.001). In SDD patients, smoking (odds ratio (OR) 13.98, P < 0.01) and older age (OR 1.13, P < 0.01) were strongly associated with readmission, while women were protected. In NSDD patients, higher body mass index and American Society of Anesthesiologists score ≥ III increased readmission risk, whereas partner status, higher hemoglobin, and non-White race were protective. Effect-size comparisons demonstrated that smoking (z = 4.34, P < 0.001) and age (z = 3.65, P < 0.001) had stronger associations with readmission in SDD patients than in NSDD patients. Readmission etiologies were similar between groups. Findings were consistent in the high-volume surgeon sub-analysis.
Conclusions
While SDD after primary THA is associated with low overall readmission rates, smoking and advanced age confer disproportionately greater readmission risk when same-day discharge is pursued. These findings suggest that smoking status and age may warrant additional attention during preoperative counseling and individualized same-day discharge decision-making, while recognizing that absolute readmission rates remain low.
Abstract Objectives: To evaluate whether same-day discharge for aseptic lower extremity nonunions is associated with increased complication rates compared with patients admitted to the hospital, aiming to determine the safety and feasibility of same-day discharge in this patient population. Methods: A retrospective cohort study was conducted across 14 Level 1 trauma centers, including 981 adult patients who underwent surgical fixation of aseptic femur or tibia nonunions between 2007 and 2022. Patients were stratified by length of stay into same-day discharge and admission to the hospital (≥1 night). Primary outcomes were postoperative complications: infection, reoperation, and readmission rates. Multivariable logistic regression controlled for confounders including age, body mass index, comorbidities, ASA classification, insurance, and bone graft use. Results: Of 981 patients, 146 (14.9%) underwent same-day discharge and 835 (85.1%) were admitted to the hospital. Patients undergoing same-day discharge were younger, healthier, and had shorter operative times. Unadjusted complication rates were higher among patients admitted to the hospital; however, after adjustment, same-day discharge was not associated with increased odds of infection (odds ratio [OR] 0.75, P = 0.386), readmission (OR 0.76, P = 0.346), or reoperation (OR 0.92, P = 0.730). No significant differences in injury characteristics or procedure types were found between groups. Conclusions: Same-day discharge for aseptic lower extremity nonunion surgery was not associated with increased complication or readmission rates compared with admission to the hospital. With careful patient selection and perioperative management, same-day discharge pathways may be safely expanded for appropriately selected patients, supporting cost-effective care without compromising outcomes. Level of Evidence: III.
Bradley J. Lauck, A. Paterno, Yu Min Suh et al.· OTA International· 0 citations
Background Socioeconomic disadvantage has been associated with poorer outcomes following total hip arthroplasty (THA). This study evaluated the relationship between social determinants of health (SDoH) and short- and long-term postoperative outcomes after primary THA. Methods A retrospective cohort study was conducted using the TriNetX Dataworks-USA network. Adult patients undergoing elective primary THA were identified and stratified based on the presence of at least 1 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) SDoH Z-code (Z55–Z65). Cohorts were matched in a 1:1 ratio using greedy nearest-neighbor propensity score matching with a caliper of 0.1 standard deviations of the logit of the propensity score, adjusting for age, sex, and medical comorbidities. Standardized mean differences <0.1 were considered indicative of adequate covariate balance. Postoperative outcomes evaluated included superficial surgical site infection, deep vein thrombosis, sepsis, myocardial infarction, and all-cause mortality at 30 days, 90 days, and 1 year following surgery. Risk ratios with 95% confidence intervals were calculated. Results After matching, 15,922 patients remained in each cohort. Patients with SDoH risk factors demonstrated significantly increased risks of superficial surgical site infection, deep vein thrombosis, sepsis, myocardial infarction, and all-cause mortality at multiple postoperative time points compared with controls. Elevated mortality risk persisted through 1 year postoperatively. Conclusions Socioeconomic disadvantage, as identified by SDoH Z-codes, was associated with worse short- and long-term outcomes following primary THA. These findings support the incorporation of social risk factors into perioperative risk stratification and optimization strategies.
Kevin Artus, Lakshay Anand, Zenya Yanoff et al.· Arthroplasty Today· 0 citations
This audit aims to determine the rates of in-hospital mortality and unplanned 30-day readmissions following lower limb bypass surgery and to identify the primary causes of readmission to target quality improvement.
A retrospective analysis was conducted on clinical records of patients undergoing lower limb bypass surgery from January 2022 to January 2023. The primary data collected comprised in-hospital mortality, 30-day readmission rates, and the underlying causes of readmission. Outcomes were benchmarked against the National Vascular Registry 2020 data.
Of 22 patients included, there was one in-hospital mortality case (4.55%), exceeding the national average of 2.9%. Readmission rates were also elevated at 36.36% compared to the national average of 12.0%. Surgical site infection was the leading cause of readmission, accounting for 50% of cases. Factors contributing to higher rates include patient case-mix complexity, perioperative protocols, postoperative care pathways, and ward environment. Notably, vascular patients were previously housed in mixed surgical wards, potentially increasing infection risk.
The study reveals elevated mortality and readmission rates relative to national benchmarks, with surgical site infections as the primary driver of readmissions. Targeted infection control measures, including stricter preoperative preparation and enhanced postoperative care, are recommended. A dedicated vascular ward has since been implemented, warranting a follow-up audit to assess its impact on these outcomes.
Own Al-Massarweh, S. Imteaz, R. Eifell· British Journal of Surgery· 0 citations
Navigation-guided total hip arthroplasty (THA) has been increasingly adopted to improve implant positioning and early outcomes; however, its population-level clinical and economic impact remains uncertain.
Using the Nationwide Readmissions Database (NRD) (2020–2022), elective primary THA performed on hospital day 0 was identified in this study. Navigation-guided cases were compared with conventional THA. A 1:5 propensity score–matched cohort was constructed adjusting for demographics, payer, comorbidities, calendar year, and hospital characteristics. Primary outcomes included index hospitalization complications and 90-day readmission with readmission-associated procedural escalation. Readmission resource utilization and modeled 100-case episode-of-care costs were assessed.
Among 366,375 elective THA procedures, navigation use increased from 2.9% (2020) to 4.3% (2022). In the matched cohort (
n
= 77,214), navigation was associated with shorter length of stay and lower rates of intraoperative fracture, blood loss anemia, acute kidney injury, and hip dislocation (all
p
< 0.01). Ninety-day readmission was lower with navigation (3.6% vs. 4.9%; odds ratio 0.72, 95% confidence interval 0.65–0.79), as were early revision and reoperation events. However, index hospitalization charges were higher (+$15,384 per case), and a modeled episode-of-care analysis did not demonstrate cost offset within 90 days.
Navigation-guided elective THA was associated with improved short-term outcomes but higher upfront charges. Because the NRD does not capture surgical approach, implant positioning, implant-specific details, surgeon volume, or longer-term outcomes, these findings should be interpreted as hypothesis-generating associations rather than definitive evidence of a causal technology effect.
D. Maman, Yaniv Steinfeld, Y. Berkovich· Frontiers in Surgery· 0 citations
Background Access to primary total knee arthroplasty (TKA) for morbidly obese (MO) patients is often restricted to reduce complications. We compared complication rates in patients who were MO or non-MO (NMO) at initial presentation based on whether their body mass index (BMI) had decreased by ≥5%, remained stable, or increased by ≥5% at the time of surgery, hypothesizing that preoperative weight loss does not reduce complication rates. Methods Prospectively collected data for 2219 unilateral, primary TKAs were retrospectively reviewed. Cases were performed between 2012 and 2023 at the same academic center by 4 fellowship-trained surgeons using standardized protocols. Twenty-eight percent (n = 627) were MO and 72% (n = 1592) were NMO at initial presentation. Outcomes included intraoperative and 90-day complications and reoperations. Outcome covariates included patient demographics and comorbidities, as well as operative details. Independent samples t-tests and chi-squared tests were used for statistical analysis. Results Intraoperative complications (P = .999), medical complications (P ≥ .398), death (P = .299), superficial or deep infection (P = .731), and reoperation on the index joint within 90 days of surgery (P = .801) did not differ in MO patients with a ≥5% decrease vs stable BMI before surgery. These outcomes also did not differ between NMO patients with a ≥5% decrease in BMI and those with stable BMI before surgery (P ≥ .250). Conclusions Findings suggest that withholding surgery from patients who are clinically indicated for TKA pending weight loss may not be necessary to reduce early postoperative complications.
John P. Lewis, M. Ziemba-Davis, Leonard T. Buller et al.· Arthroplasty Today· 0 citations
BACKGROUND
Revision ankle arthrodesis (AA) is traditionally considered more technically complex and associated with increased postoperative morbidity compared with primary AA. Emergency department (ED) utilization has emerged as an important measure of postoperative healthcare utilization, yet direct comparisons between primary and revision AA are limited.
PURPOSE
To compare 1-year postoperative ED utilization following primary vs revision AA STUDY DESIGN: Retrospective comparative cohort study METHODS: Following institutional review board approval, patients who underwent AA between 2015 and 2025 at a single institution were identified and stratified into primary and revision cohorts. ED utilization within 1 year postoperatively was evaluated. Patients were matched 1:1 using propensity score matching based on age, body mass index, sex, smoking status, diabetes, and medical comorbidities. Risk differences, risk ratios, and odds ratios with 95% confidence intervals (CIs) were calculated. Timing and indications for ED presentation were assessed.
RESULTS
A total of 463 patients were included (391 primary, 72 revision). After propensity matching, 68 revision patients were matched to 68 primary patients with adequate covariate balance. One-year ED utilization occurred in 22 of 68 primary AA patients (32.4%) compared with 6 of 68 revision AA patients (8.8%). Revision AA was associated with a lower risk of ED utilization (risk difference, -23.5%; 95% CI, -36.5% to -10.5%; risk ratio, 0.27; 95% CI, 0.12-0.63; odds ratio, 0.20; 95% CI, 0.08-0.54). Infection was the most common indication for ED presentation in both cohorts.
CONCLUSIONS
In this propensity-matched analysis, revision AA was not associated with increased postoperative ED utilization and demonstrated lower observed ED utilization than primary AA. Infection remained the leading cause of postoperative ED presentation.
Trenton Pritt, Akhil Bolisetti, George Yacoub et al.· Journal of Foot and Ankle Su...· 0 citations