Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup

BACKGROUND: Day-case hip and knee arthroplasty can reduce bed occupancy and improve cost-effectiveness, which is crucial for addressing the increasing demand among hip and knee osteoarthritis patients. This study investigated how different arthroplasty center setups were associated with the implementation and day-of-surgery (DOS) discharge rates of a standardized day-case setup. MATERIALS AND METHODS: We included unilateral primary hip and knee arthroplasty patients from seven fast-track arthroplasty centers, all implementing a standardized day-case setup in September 2022 with identical eligibility and discharge criteria. Centers were categorized as: Satellite Arthroplasty Centers (SACs): Only primary arthroplasties, separate logistics. Elective Arthroplasty Centers (EACs): Complex primaries, revisions, separate logistics. Arthroplasty Unit Orthopedic Departments (AUOs): Primary and revision procedures, integrated into a general orthopedic department. We compared DOS discharge rates from September 2022 to September 2023 with a baseline period (July 2019-December 2019) using crude percentages. We compared the DOS discharge rate for day-case-eligible patients in study period between the center types using mixed effects models. RESULTS: We included 6718 patients (1357 SAC, 4309 EAC, 1052 AUO) during the study period and 3974 in the baseline period. DOS discharge rates increased post-implementation across all centers (SAC: 3.9% to 30%, EAC: 5.5% to 23%, AUO: 7.4% to 14%). Compared with AUOs (36%), successful DOS discharge among eligible patients was more likely in SACs (54%; adjusted OR 3.0, 95% CI 1.3-7.1; adjusted risk difference 25 percentage points, 95% CI 5.9-44) and EACs (60%; adjusted OR 3.8, 95% CI 1.7-8.5; adjusted risk difference 31 percentage points, 95% CI 13.8-48). CONCLUSIONS: Arthroplasty centers with logistics separate from the general orthopedic department, SACs and EACs, were associated with higher rates of successful DOS discharge among eligible patients during implementation of a standardized day-case pathway, despite integrated arthroplasty units, AUOs, having higher day-case surgery use before implementation.