Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting

Abstract

Background and purpose: Length of hospital stay after hip and knee arthroplasty is about 1 day in Denmark with few patients discharged on the day of surgery. Hence, a protocol for multicenter implementation of discharge on day of surgery has been instituted. We aimed to describe the implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting. Methods: We performed a prospective multicenter study from 7 public hospitals across Denmark. Patients were screened using well-defined in- and exclusion criteria and were discharged on day of surgery when fulfilling functional discharge criteria. The study period was from September 2022 to February 2023 with variable start of implementation. Data from the same centers in a 6-month period before the COVID pandemic from July 2019 to December 2019 was used for baseline control. Results: Of 2,756 primary hip and knee arthroplasties, 37% (95% confidence interval [CI] 35–39) were eligible (range 21–50% in centers) and 52% (range 24–62%) of these were discharged on day of surgery. 21% (CI 20–23) of all patients (eligible and non-eligible) were discharged on day of surgery with a range of 10–31% within centers. This was an additional 15% (CI 13–17, P < 0.001) compared with patients discharged in the control period (6% in 2019). Conclusion: We found it possible to perform outpatient hip and knee replacement in 21% of patients in a public healthcare setting, probably to be increased with further center experience.

Keywords

• Arthroplasty
• Hip
• Implementation
• Knee