Same-day discharge after TJA found safe in community hospital setting
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General anesthesia used in patients undergoing total joint arthroplasty in the community hospital setting was associated with complications that deterred same-day discharge or failure to launch, results of retrospective study showed.
However, investigators at St. Peter’s Health Partners in Albany, New York, who conducted the study, found overall, same day discharge (SDD) was safe in this setting.
At the American Association of Hip and Knee Surgeons Annual Meeting, Curtis T. Adams, MD, JD, presented the results of 1,200 patients who underwent primary total hip arthroplasty (582 patients) or total knee arthroplasty (618 patients) at a community hospital with the intention of having SDD. Investigators deemed the inability for a successful SDD as a failure to launch (FTL) and sought to determine why this occurred in the study group.
Spinal anesthesia, which was used more often than general anesthesia in the patients, was received by 1,087 patients compared to general anesthesia, which was received 113 patients. In all, there were 85 instances of FTL, according to the abstract.
“SDD total joint arthroplasty is both safe and successful for a majority of patients,” Adams said. “There remain about 7% in our patient population of patients who demonstrate FTL. This is something we need to think about as we transition to ambulatory surgery centers. This risk is markedly increased with general anesthesia.”
Among patients with general anesthesia, results showed the most common factors associated with FTL were related to the inability to mobilize or work with physical therapy, including somnolence, fatigue and grogginess, which occurred in 26% of the patients, Adams said.
“Orthostatic hypotension was next, followed by urinary retention and cardiac arrythmias requiring monitoring or workup overnight,” he said.
Among patients with spinal anesthesia or a block, the most common factors associated with FTL were neuropraxia, which Adams and colleagues defined as any leg weakness, numbness or buckling that caused patients to be unable to ambulate safely.
“Specifically, 18% or roughly half of those patients had isolated quadriceps weakness which was likely from an adductor canal block with some effect on the femoral nerve,” Adams said, noting other issues the spinal anesthesia or block group experienced related to FTL included orthostatic hypotension, urinary retention and cardiac issues.
He said bracing and physical therapy are viable options to use in patients who desire SDD, but develop footdrop, neuropraxia or quadriceps or ankle weakness postoperatively.
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Adams CT, et al. Paper 7. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 5-8, 2020; Dallas (hybrid meeting).
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