Ryan Nguyen¹, Dylan R.Y. Lawton¹, Landon Morikawa¹, Rosana Hernandez Weldon⁴, Samantha Andrews² and Cass K. Nakasone^2,3

¹John A Burns School of Medicine, University of Hawai’i, Honolulu, USA
²Straub Medical Center, Department of Orthopedic Surgery, Honolulu, USA
³University of Hawai’i, John A Burns School of Medicine, Department of Surgery, Honolulu, USA
⁴University of Hawaii at Manoa, Office of Public Health Studies, Honolulu, HI, USA

*Corresponding Author: Nakasone Cass K, Straub Medical Center, Department of Orthopedic Surgery, and University of Hawai’i, John A Burns School of Medicine, Department of Surgery, Honolulu, USA.

Received: September 06, 2023; Published: September 12, 2023

Abstract

Background: Predicting which patients will successfully achieve same-day discharge (SDD) following unicondylar knee arthroplasty (UKA) continues to be challenging. This study evaluated the efficacy of three comorbidity indices in predicting successful SDD in unselected patients treated in a community hospital setting.

Methods: Data for 97 UKA patients were retrospectively examined. Patient demographics, the American Society of Anesthesiology (ASA) comorbidity classification, Charlson Comorbidity Index (CCI), and Outpatient Arthroplasty Risk Assessment (OARA) score were the independent variables determined for each patient. Day of discharge was the dependent variable of interest. Multivariable logistic regression models were constructed to assess the associations between independent and dependent variables.

Results: Overall, 77 (79.4%) patients achieved SDD, with SDD failure best predicted by gender (Odds Ratio (OR): 4.45, 95% Confidence Interval (CI): 1.307-15.147) and pre-operative need for an assistive walking device (OR: 3.633, CI: 1.218-10.832). The ASA, CCI, and OARA demonstrated similar positive predictive values, but were not significant indicators of SDD success. While racial group was not different between SDD and next day discharge groups, differences in race were present with White patients having a greater proportion with OARA scores >79 and >110, compared to Asian and Native Hawaiian/Pacific Islander patients (p = 0.046 and p = 0.010, respectively).

Conclusions: None of the comorbidity indices that were evaluated accurately predicted which patients would fail SDD following unilateral UKA. The OARA score was the only measure different between racial groups. Future research should reexamine and develop better clinical tools to identify patients at high risk for failing SDD. The current classification systems may not be equally applicable to racial groups other than White.

Keywords: Same Day Discharge; Charlson Comorbidity Index; American Society Anesthesiology; Outpatient Arthroplasty Risk Assessment; Unicondylar Knee Arthroplasty

References

1. Huang A., et al. “Cost savings of outpatient versus standard inpatient total knee arthroplasty”. Canadian Journal of Surgery 1 (2017): 57-62.
2. Aynardi M., et al. “Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study”. HSS Journal 3 (2014): 252-255.
3. Gondusky JS., et al. “Day of surgery discharge after unicompartmental knee arthroplasty: an effective perioperative pathway”. The Journal of Arthroplasty 3 (2014): 516-519.
4. Cross MB and Berger R. “Feasibility and safety of performing outpatient unicompartmental knee arthroplasty”. International Orthopaedics 2 (2014): 443-447.
5. Matsumoto M., et al. “Barriers to achieving same day discharge following unilateral unicompartmental knee arthroplasty”. Knee5 (2020): 1365-1369.
6. Nakasone CK., et al. “Day of surgery discharge success after implementation of a rapid discharge protocol following unilateral unicompartmental knee arthroplasty”. Knee3 (2020): 1043-1048.
7. Van den Belt L., et al. “Predictive factors of length of hospital stay after primary total knee arthroplasty”. Knee Surgery, Sports Traumatology, Arthroscopy 6 (2015): 1856-1862.
8. Charlson ME., et al. “A new method of classifying prognostic comorbidity in longitudinal studies: development and validation”. Journal of Chronic Diseases 5 (1987): 373-383.
9. Meneghini RM., et al. “Safe Selection of Outpatient Joint Arthroplasty Patients With Medical Risk Stratification: the "Outpatient Arthroplasty Risk Assessment Score". The Journal of Arthroplasty 8 (2017): 2325-2331.
10. Kim KY., et al. “Rapid Discharge in Total Hip Arthroplasty: Utility of the Outpatient Arthroplasty Risk Assessment Tool in Predicting Same-Day and Next-Day Discharge”. The Journal of Arthroplasty 8 (2018): 2412-2416.
11. Polisetty TS., et al. “Determining the validity of the Outpatient Arthroplasty Risk Assessment (OARA) tool for identifying patients for safe same-day discharge after primary shoulder arthroplasty”. Journal of Shoulder and Elbow Surgery 8 (2021): 1794-1802.
12. Ziemba-Davis M., et al. “Outpatient Joint Arthroplasty-Patient Selection: Update on the Outpatient Arthroplasty Risk Assessment Score”. The Journal of Arthroplasty 7S (2019): S40-S43.
13. Kain ZN., et al. “The perioperative surgical home as a future perioperative practice model”. Anesthesia and Analgesia 5 (2014): 1126-1130.
14. Naito K., et al. “Can a community hospital successfully transition to outpatient total knee arthroplasty in unselected patients?” Knee 41 (2023): 322-328.
15. Adachi RN., et al. “Tempering expectations for outpatient total knee arthroplasty for patients over 70”. The Journal of Arthroplasty 4 (2022): 704-708.
16. Sakka B., et al. “True “Outpatient Discharge” Following Single-Stage Bilateral Unicompartmental Knee Arthroplasty May Be Unrealistic for Most”. Archives of Orthopaedic and Trauma Surgery (2023).
17. Baker P., et al. “Stepping toward outpatient total hip arthroplasty with a rapid discharge protocol”. Journal of Orthopaedics 27 (2021) 153-157.

Citation

Citation: Ryan Nguyen., et al. “Published Comorbidity Indices Poorly Identify Patients at Risk for Failing to Achieve Same Day Discharge Following Unilateral Unicondylar Knee Arthroplasty". Acta Scientific Orthopaedics 6.10 (2023): 15-20.

Copyright

Copyright: © 2023 Nakasone Cass K., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.