The Knee, ISSN: 0968-0160, Vol: 27, Issue: 6, Page: 1963-1970

Same-Day Bilateral Total Knee Arthroplasty: Incidence and Perioperative Outcome Trends from 2009 to 2016

Remily, Ethan A; Wilkie, Wayne A; Mohamed, Nequesha S; Gilson, Greg; Smith, Tyler; Zweigle, Joshua W; Nace, James; Delanois, Ronald E
Knee

Background

Same-day bilateral total knee arthroplasty (BiTKA) is a controversial topic in orthopedics, prompting a consensus statement to be released by national experts. To date, no studies have evaluated the trends of this method since these recommendations. This study utilized a national database to evaluate: 1) incidence; 2) patient characteristics; 3) hospital characteristics; and 4) inpatient course for same-day BiTKAs in the United States from 2009 to 2016.

Method

The National Inpatient Sample database was queried for individuals undergoing same-day BiTKAs, yielding 245,138 patients. Patient demographics included age, sex, race, obesity status and Charlson Comorbidity Index (CCI) score. Hospital characteristics consisted of location/teaching status, geographic region, charges, and costs. Inpatient course included length of stay, discharge disposition, and complications.

Results

Same-day BiTKA incidence decreased from 5.6% to 4.0% over the study ( p < 0.001). Decreases in patient age and female proportion ( p < 0.001 for both) were seen, while African American and Hispanic patients increased ( p < 0.001), as did obese patient proportions ( p < 0.001). Patients with CCI scores of 2 increased, while those with ≥3 decreased ( p < 0.001). Hospital charges increased, while costs decreased ( p < 0.001 for both). Length of stay following same-day BiTKA decreased ( p < 0.001) and routine home discharges increased ( p < 0.001). Most inpatient complications decreased, although the percentage of mechanical complications and respiratory failures increased ( p < 0.01 for all).

Conclusions

During the study period, younger patients with fewer comorbidities underwent BiTKAs, which likely resulted from improved patient assessment and management. Future investigations should include an evaluation of long-term complications and outcomes in certain patient populations for this procedure.

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