Risk Factors for Return to the Emergency Department and Readmission After Same-Day Discharge Total Joint Arthroplasty

Introduction Same day discharge (SDD) after total joint arthroplasty (TJA) is safe and cost effective. However, benefits may be offset by the potential cost of emergency department (ED) visits and readmissions. We identified risk factors for return to the ED and readmission in patients who underwent SDD and inpatient (IP) stays after TJA. Methods We performed a retrospective review of patients who underwent primary TJA at an academic institution over the course of one year. There were 1,708 consecutive TJAs (721 THA [total hip arthroplasty] and 987 TKA [total knee arthroplasty]) included. A SDD occurred after 1,199 (70%) TJAs, 523 THAs, and 676 TKAs. We compared the demographics and comorbidities of patients who have SDD or IP who stayed following TJA. We documented rates of return to the ED or readmission within 90 days of surgery. Cohorts were compared using the Student’s t-test or Chi-squared test. Significant findings were those with P-value <0.05. Results The SDD cohort had a significantly higher rate of young, non-White men who had a lower body mass index (BMI) and fewer comorbidities than the IP cohort. Rates of return to ED and readmission were similar between SDD and IP cohorts after TJA and similar between THA and TKA. Factors that significantly influenced return to ED included a higher American Society of Anaesthesiologists (ASA) score (SDD, IP), a higher Charlson Comorbidity Index (CCI) score (SDD, IP), a lower BMI (IP), and a psychological diagnosis (SDD, IP). Factors that significantly influenced readmission rates included a higher ASA score (SDD), older age (SDD), and psychological diagnosis (SDD, IP). Conclusion Patients who discharge the same day after primary TJA have similar rates of return to the ED and readmission as those admitted as an inpatient. Patients who had a psychological diagnosis, and particularly a diagnosis of depression, are at higher risk for return to the ED and readmission after primary TJA, regardless of discharge the same-day or inpatient admission. Improved measures that attempt to further treat and optimize this patient population could reduce unnecessary postoperative ED visits.