SAME-DAY DISCHARGE HIP ARTHROPLASTY SURGERY IN ENGLAND: AN EXPLORATION OF TRENDS IN USE, SAFETY, FINANCIAL COSTS, AND CARBON FOOTPRINT USING ADMINISTRATIVE DATA

Same-day discharge (SDD) total hip arthroplasty (THA), although still only performed regularly in a few hospital trusts in England, is becoming more common. If achieved safely then, not only could it improve patient outcomes, but also significantly reduce the carbon footprint of the service. Hospital Episodes Statistics data from April 2017 to March 2024 were extracted. Adults undergoing primary elective THA were included. The primary outcome was 30-day emergency readmission following surgery with propensity score matching used to compare outcomes for SDD patients and those with inpatient stay. Carbon emissions for index and readmission days stay and emergency department attendance were calculated. Data was available for 461,173 patients, of whom 6,531 (1.4%) were discharged on the same-day as admission. SDD rates increased from 0.5% in 2017/18 to 3.0% in 2023/24. For 2023/24 (n = 75,693) and following propensity score matching, SDD was not associated with a higher 30-day emergency readmission rate and was associated with significantly fewer post-procedural complications. The mean per-patient carbon emissions for the key elements considered were estimated as 6.2 KgCO 2 e for SDD and 113.4 KgCO 2 e for inpatient stay patients. In 2023/24 if all trusts below the upper quartile for SDD rate were to meet this target, 1569 tonnes CO 2 e could be saved, enough to power 1427 average UK homes with electricity for one year From this national dataset of analysed SDD THA, we found no evidence that SDD THA was unsafe when compared to inpatient THA. Increasing rates of SDD THA could have a substantial impact unit length of stay, overall costs and on carbon emissions associated with THA.