Patient safety after day-case and non-day-case fast-track hip and knee arthroplasty: a multicentre, prospective cohort study from a public healthcare setting

AIMS: The aim of this study was to investigate patient safety, defined using in-hospital complications, early readmissions, mortality, and days alive and at home (DAH), after day-case and non-day-case hip and knee arthroplasty in a public healthcare setting.

METHODS: This multicentre cohort study included consecutive patients who underwent primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) between September 2022 and May 2024. All eight public hospitals which were involved followed the same standardized protocol with consistent eligibility for day-case surgery and discharge criteria. Postoperative hospital contacts within 30 days were recorded using the patients' medical records and electronic questionnaires. Day-case surgery was defined as discharge on the day of surgery to the patient's own home.

RESULTS: A total of 12,607 patients were included, of whom 3,159 (25%) were day-case and 9,430 (75%) were non-day-case patients. The mean length of hospital stay (LOS) was one day (0 to 70); 5% of patients (95% CI 4.9 to 5.5) had a LOS of > two days, primarily due to mobilization issues (1.4%) and pain (1.3%). The overall readmission rate was 0.5% (95% CI 0.4 to 0.7) within 48 hours and 4.4% (95% CI 4.1 to 4.8%) within 30 days. Readmission rates were 0.7% (95% CI 0.5 to 1.1) and 1.9% (95% CI 1.5 to 2.5) for day-case patients, and 0.5% (95% CI 0.3 to 0.6) and 5.3% (95% CI 4.8 to 5.8) for non-day-case patients within 48 hours and 30 days, respectively. When stratified by the type of surgery, there were only minor variations. No patients died within 48 hours, and the overall 30-day mortality was 0.08% (n = 10), with no deaths among day-case patients. The median DAH 30 was 30 (IQR 30 to 30) for day-case patients and 29 (IQR 29 to 29) for non-day-case patients.

CONCLUSION: These findings indicate that fast-track surgery with a one-day LOS and a 25% day-case rate in a national, publicly funded healthcare system is safe, based on low rates of in-hospital complications, early readmission, mortality, and a high DAH 30.