Abstract
Total knee arthroplasty (TKA) is becoming an increasingly common procedure to alleviate
knee pain often associated with osteoarthritis. As the number of revision TKAs performed
continues to increase, there remains a debate regarding the efficacy of discharging
patients earlier than the conventional 3 to 4 days in the postoperative period. A
variety of studies have begun to show that interchangably discharge in the primary
TKA setting has an economical benefit while causing either a reduction or no difference
in patient outcomes. This study aims to determine the effect of rapid discharge at
0- to 2-day postoperative stay compared to the conventional 3- to 4-day postoperative
stay on postdischarge complications in patients undergoing revision TKA. A retrospective
cohort study was conducted using data collected through the American College of Surgeons
National Quality Improvement Program Database. All patients who underwent aseptic
revision TKA between 2005 and 2016 were identified and stratified into groups based
on length of stay: 0 to 2 days versus 3 to 4 days. Patients suffering from predischarge
complications were excluded to minimize bias. Single-component versus both-component
revisions were analyzed. The incidence of adverse events following discharge was evaluated
with univariate and logistic multivariate analyses where appropriate. Patients who
underwent single-component revisions and were discharged rapidly were less likely
to develop minor complications (p = 0.001; odds ratio [OR]: 0.355; 95% confidence interval [CI]: 0.188–0.671) and septic
complications (p = 0.016; OR: 0.011; 95% CI: 0–0.430) within the 30-day postoperative period. No differences
were observed in discharge cohorts among patients undergoing both-component revisions.
We found that rapid discharge following aseptic revision TKA is not associated with
increased risks for postoperative complications. Rapid discharge may have benefits
for healthy patients undergoing single-component revisions. Careful selection of revision
TKA patients for rapid discharge may help to lower the increasing costs of the procedure
and improve patient outcomes. Further study is required to refine the selection criteria
to identify patients eligible for short stay or outpatient revision TKA.
Keywords knee - replacement - arthroplasty - postoperative - complications
