Same-Day Discharge Following Total Joint Arthroplasty: Examining Trends, Discharge Dispositions, and Complications Over Time.

Administrative database studies have reported on the safety of same-day discharge (SDD) following total joint arthroplasty (TJA); however, most patient cohorts have been defined by length of stay (LOS), and the proportion discharged directly home remains unknown. The purpose of this investigation was to (1) determine common dispositions for patients undergoing SDD TJA; (2) understand changes in discharge disposition over time; and (3) determine the safety of SDD TJA, stratified by discharge disposition. The PearlDiver Database was reviewed for patients who underwent SDD TJA (LOS of 0 days) from 2011 to 2016. Patients were stratified by discharge disposition, and rates and complications following SDD TJA were assessed accordingly. Chisquare analysis was performed to compare demographics and complications between patient groups stratified by disposition. From 2011 to 2016, there was an exponential increase in the annual rate of SDD TJA from 0.95% to 20.5%, respectively; however, the annual proportion of patients discharged directly home remained unchanged (approximately 68%), with the remaining discharged directly to an alternate care facility, most commonly inpatient rehabilitation. Patients discharged to an alternate facility were significantly older (P<.001), had significantly higher comotbidity scores (P<.001), and had significantly more complications (P<.001) than those patients discharged directly home. Although the annual rate of SDD TJA is increasing, up to one-third of patients are not discharged directly home-a proportion unchanged over time. Moving forward, administrative database studies examining SDD TJA must account for discharge disposition; moreover, there is a need to understand the practice of SDD TJA to an alternate care facility.