The Effect of the COVID Pandemic on the Rate of Same-Day Discharge in Primary Hip and Knee Arthroplasty

Introduction Same-day discharge (SDD) following primary total hip (THA) and total knee (TKA) arthroplasty started increasing prior to 2020. The purpose of this study was to evaluate the change in the rate of SDD after the pandemic and determine whether those changes became permanent. Methods The annual rate of SDD for 15,208 primary THA and TKA cases performed between January 1, 2015, and September 9, 2022, at a single institution was determined. We also examined changes in SDD patient demographics as well as differences in the 90-day complication rates of SDD and overnight patients. Results In 2015, the rate of SDD for primary arthroplasty was 24%, which grew annually to 29% in 2019. Post-pandemic, the rate of SDD jumped above 50% and continued up to 64% by 2022. The biggest increase was in TKA, which went from under 10% SDD pre-pandemic to 50% by 2022. The average age and BMI of SDD cases pre-pandemic increased significantly to 62 ± 9 years and 29.4 ± 5.3 (P < 0.01). Overnight patients had higher rates of 90-day postoperative complications (8.4 versus 4.2%, P < 0.00001). Discussion The pandemic caused major changes in the rate of SDD for primary THA and TKA, increasing in subsequent years. The SDD patients became older and heavier due to the expanded criteria for SDD cases. The 90-day postoperative complication rate was lower for SDD patients since higher risk patients were kept overnight. At the pre-pandemic rate, 29% of patients currently being sent home would have stayed overnight.