Care Hotel With Virtual Monitoring as an Alternative Recovery Pathway for Outpatient Total Joint Arthroplasty: Safety and Patient Experience

Background As total hip (THA) and knee arthroplasty (TKA) transition toward outpatient care, medical centers need to create models to support same-day discharge (SDD) for all patients, particularly those traveling long distances. A care hotel (CH) with virtual monitoring represents a novel postoperative recovery pathway, and our study evaluates patient safety and experience of this alternative model. Methods We retrospectively analyzed 5324 primary THA and TKA patients from a single tertiary referral center between July 2021 and April 2025. Of these, 590 cases (11%) utilized the CH pathway and were compared to traditional inpatient (IP), and SDD cohorts. Outcomes included demographic characteristics, 30-day emergency department (ED) utilization, hospital readmission rates, and patient-reported experience metrics. Results The 30-day ED return rate for CH patients was significantly lower than IP group (3.9 vs 6.8%, P = .006). The CH ED return rate was also lower than SDD; however, not statistically significant (3.9 vs 5.5%, P = .15). Among those returning to the ED, hospital readmission rates were 47.8% for CH, 39.3% for IP and 31.8% for SDD ( P > .22). Patient satisfaction among responders was high, with 94% of CH patients reporting they would be likely or very likely to recommend the alternative recovery pathway. Conclusions The CH provides a safe, well-received recovery pathway for THA and TKA patients with low ED utilization, acceptable readmission rates, and high patient satisfaction among responders. The CH model may represent a scalable strategy to expand access for outpatient THA and TKA while preserving hospital resources.