Adrien Alexandre
Introduction
Same-day (Day-0) discharge following hip and knee arthroplasty is increasingly encouraged to improve patient flow and reduce hospital bed utilisation. However, concerns remain regarding patient preferences and potential impact on outcomes. This study aims to identify factors associated with accelerated discharge and explore patient preferences.
Methods
A retrospective cohort study was conducted at the Hampshire Orthopaedic Centre, from September 2025. Variables included demographics, operative details, and patient-reported outcome measures via telephone. Operations were limited to hip and knee arthroplasties. Statistical analysis performed with Mann-Whitney U and Fisher’s exact tests.
Results
Of the 50 patients who responded, 23 (46%) were discharged Day-0. Although 56% of patients preferred Day-0 discharge, only 54% received their preferred discharge date. Afternoon surgical start times was significantly associated with delayed discharge (p = 0.016). Patient-reported readiness at time of discharge strongly correlated with preference for Day-0 discharge (p < 0.001). Higher satisfaction (p = 0.016) and better pain control (p = 0.033) were also linked to Day-0 preference. Knee arthroplasty patients showed a trend towards preferring same-day discharge. However, notably 24% received no physiotherapy follow up. Patients cited worries about transport, potential complications, and pain control as primary reasons for delaying discharge.
Conclusion
There is a gap in patient preference versus actual discharge date. Surgical timing is the primary determinant of discharge timing, whilst patient preference is significantly influenced by pain control, satisfaction, and perceived readiness. Addressing gap in list management, pre-operative assessment, and post-operative pain control may improve outcomes and uptake of same-day discharge.
Authors
Adrien Alexandre, James Finnigan, Thomas Ranaboldo, Shilpith Shetty
Hampshire Hospitals NHS Foundation Trust, Basingstoke, United Kingdom