Does Discharge Disposition or Length of Stay for Patients Undergoing Staged Bilateral Total Joint Arthroplasty Change Between First and Second Procedures?

Introduction This study investigates whether ambulatory surgery rates, discharge disposition, or hospital length of stay (LOS) differ between the first and second surgeries for staged bilateral total joint arthroplasty (TJA). We hypothesize that patients have higher rates of ambulatory surgery and shorter LOS for the second surgery. Methods Data were retrospectively collected from staged bilateral total knee (TKA) or total hip arthroplasty (THA) patients within a 12-month period. Ambulatory surgery rates, discharge to home, and LOS after first (LOS_1) vs. second surgery (LOS_2) were compared. Multivariable regression analysis was performed to identify predictors of shorter LOS. Results Rates of ambulatory surgery were significantly higher after second surgery for TKA (28.7% vs. 20.2%, p<0.001) but not for THA (24.8% vs. 23.0%, p=0.405). Likelihood of discharge to home was not significantly different between first and second surgeries for TKA (p=0.225) or THA (p=0.248). LOS_2 was significantly shorter than LOS_1 for TKA (1.4 vs 1.6 days, p=0.005) but not for THA (1.4 vs 1.4 days, p=0.723). Undergoing TKA (OR=1.846, 95% CI=[1.142, 2.984]), former smoking (OR=1.686, 95% CI=[1.068, 2.660]), and younger age (OR=0.968, 95% CI=[0.939, 0.997]) were associated with LOS_2<LOS_1. Conclusions Our results show higher rates of ambulatory surgery and shorter LOS after second surgery vs. first for staged bilateral TKA but not THA. Factors associated with LOS_2<LOS_1 include undergoing TKA, former smoking, and younger age.