10-year evolution of day-case hip and knee arthroplasty: a Danish nationwide register study of 166,833 procedures from 2010 to 2020

Abstract

Background and purpose: No previous studies have investigated the use of day-case arthroplasty in Denmark on a national scale. We investigated the frequency of day-case surgery in total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA) from 2010 to 2020 in Denmark.Patients and methods: Primary unilateral THAs, TKAs, and UKAs performed for osteoarthritis were identified in the Danish National Patient Register using procedural and diagnosis codes. Day-case surgery was defined as discharge on the day of surgery. 90-day readmissions were defined as any overnight admissions following discharge.Results: From 2010 to 2020 Danish surgical centers performed 86,070 THAs, 70,323 TKAs, and 10,440 UKAs. From 2010 to 2014, less than 0.5% of THAs and TKAs were day-case procedures. They increased to 5.4% (95% confidence interval [CI] 4.9–5.8) of THAs and 2.8% (CI 2.4–3.2) of TKAs in 2019. From 2010 to 2014, 11% of UKAs were day-case procedures, but they increased to 20% (CI 18–22) in 2019. This increase was driven by a few surgical centers (3–7 centers). In 2010, readmission rates within 90 days of surgery were 10% after THAs and 11% after TKAs, and 9.4% for both THAs and TKAs in 2019. Readmission rates after UKA fluctuated between 4% and 7%.Conclusion: From 2010 to 2020 the use of day-case surgery in THA, TKA, and UKA increased in Denmark, driven by only a few centers. During the same period readmissions did not increase.

Adapting hip arthroplasty practices during the COVID-19 pandemic: Assessing the impact of outpatient care sudden increase on early complications and clinical outcomes

“…While the shift towards ambulatory surgery is often stepwise [ 14 – 16 ], our institution faced a swift change in practice. Mitchell et al recently disseminated findings of a similar study, comparing the management evolution between 2019 and 2020 at a single centre in the United States [ 27 ].…”

“…There is mounting evidence suggesting the safety and efficacy of outpatient THR [ 9 – 12 ], with some groups reporting up to 75% utilisation of outpatient management [ 13 ]. While the transition to outpatient surgery typically involves a stepwise process amongst all stakeholders involved in patient care [ 14 – 16 ], the recent pandemic has necessitated rapid adaptation in practice.…”

Effect of high-dose glucocorticoids on persistent opioid use 3 to 12 months after primary total hip or knee arthroplasty. Protocol for a target trial emulation using observational data from Danish registries

“…1,2 Enhanced Recovery After Surgery (ERAS) guidelines are widely implemented in Denmark and half of the patients are discharged home the day after surgery. 1,2,19 Eligibility criteria: All eligibility criteria will be assessed at time of surgery. All adults (≥18 years old) who underwent elective, unilateral THA or TKA due to primary osteoarthritis between 1 January 2010 and 31…”

Implementation of outpatient hip and knee arthroplasty in a multicenter public healthcare setting

“…Previous single-center studies have shown the potential to discharge patients on the day of surgery after primary total hip arthroplasty (THA), total knee arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) [ 7 - 10 ]. Although selective use of outpatient surgery in individual centers has been shown to be feasible, the use of outpatient surgery on a national level is low [ 11 , 12 ]. Therefore, the study group designed a detailed protocol for the implementation of outpatient surgery in a multicenter collaboration across all regions in Denmark [ 13 ].…”