Same-day discharge does not increase complications or readmissions in carefully selected patients undergoing aseptic lower extremity nonunion surgery

Abstract Objectives: To evaluate whether same-day discharge for aseptic lower extremity nonunions is associated with increased complication rates compared with patients admitted to the hospital, aiming to determine the safety and feasibility of same-day discharge in this patient population. Methods: A retrospective cohort study was conducted across 14 Level 1 trauma centers, including 981 adult patients who underwent surgical fixation of aseptic femur or tibia nonunions between 2007 and 2022. Patients were stratified by length of stay into same-day discharge and admission to the hospital (≥1 night). Primary outcomes were postoperative complications: infection, reoperation, and readmission rates. Multivariable logistic regression controlled for confounders including age, body mass index, comorbidities, ASA classification, insurance, and bone graft use. Results: Of 981 patients, 146 (14.9%) underwent same-day discharge and 835 (85.1%) were admitted to the hospital. Patients undergoing same-day discharge were younger, healthier, and had shorter operative times. Unadjusted complication rates were higher among patients admitted to the hospital; however, after adjustment, same-day discharge was not associated with increased odds of infection (odds ratio [OR] 0.75, P = 0.386), readmission (OR 0.76, P = 0.346), or reoperation (OR 0.92, P = 0.730). No significant differences in injury characteristics or procedure types were found between groups. Conclusions: Same-day discharge for aseptic lower extremity nonunion surgery was not associated with increased complication or readmission rates compared with admission to the hospital. With careful patient selection and perioperative management, same-day discharge pathways may be safely expanded for appropriately selected patients, supporting cost-effective care without compromising outcomes. Level of Evidence: III.