Jack Dufficy
Introduction
Day-case total hip (THA) and knee arthroplasty (TKA) is an emerging NHS initiative with potential to reduce waiting times and cost while maintaining safety. A preceding trust audit identified our mean length of stay (LOS) as 5.4 days for TKA and 4.3 days for THA, providing impetus for a day-case pilot at our NHS
district general hospital.
Methods
We retrospectively anaylsed a 179 patient cohort, March 2024 - January 2026. All elective arthroplasty patients (ASA 1-4) with primary or aseptic revision THA and TKA were included. Our pilot utilised standardised anaesthetic, surgery and postoperative protocols. Primary outcome was LOS, with subgroup analyses determining discharge-delay and patient safety relationships.
Results
Mean patient ASA score was 2.24 with 31.8% ASA >2. Overall, 35.8% (95% CI 28.7–42.8%) were day 0 discharges and 71.5% (95% CI 64.9–78.1%) day 1. THA yielded higher day 0 and 1 discharge than TKA (40.8% day 0 (95% CI 31.1–50.5%), 75.5% (95% CI 67.0–84.0%) day 1 vs 29.6% (95% CI 19.7–39.6%) day 0, 66.7% (95% CI 56.4–76.9%) day 1). Mean overall LOS was 1.5 (95% CI 1.14–1.86) days with 9 re-admissions within 1 year (5%).
Conclusion
Day case hip and knee arthroplasty has had a significant positive effect on LOS and cost efficiency in our NHS district general hospital while maintaining patient safety. Wider adoption within large and small NHS centres is feasible, practical and represents a significant positive effect on efficiency in elective orthopaedics while maintaining high patient safety standards.
Authors
Jack Dufficy, Alex Kurowski-Ford, Chelsea Street, Fahad Hossain, mohmad salim
Thomas Moores Walsall Manor Hospital, Birmingham, United Kingdom