Postoperative morbidity and mortality in total joint arthroplasty: Exploring the limits of early discharge.

Introduction: In order to enhance cost-effectiveness, shorter hospital stays have been adopted following hip or knee replacement surgery. This study seeks to describe the incidence of morbidity and mortality, five days after patients were taken to surgery with an expected hospital stay of four days.
Methods: Utilizing an Institutional Joint Replacement database, a descriptive study was carried out using a retrospective cohort of 1233 procedures in 1100 patients between 2012 and 2016. These were followed up for three months to evaluate morbidity and mortality in the postoperative period.
Results: Complications were classified as minor or major (these were defined as any adverse event that can threaten a patient's life or had the potential to result in readmission). Of the cohort, 18 (1.5%) patient procedures presented one or more major complications. On the first postoperative day 3 major complications occurred (including one death). On the second and third day, 4 major complications were registered each day. On the fourth day after surgery, there were no major complications. On the fifth day 1 major complication was identified. After patient discharge there were 6 major complications reported.
Discussion: The balance between early discharge and out-of-hospital morbidity as well as the frequency of hospital readmission must be the basis to determine whether a patient's hospital stay should be reduced. According to our results, it seems to be safe to shorten hospital stay in young and healthy patients. Furthermore, only orthopedic teams that have minimal rates of outpatient complications and adhere to high standards of care should consider reducing hospital stay.
Competing Interests: Camilo Gutiérrez Rodríguez MD: declares that he has no conflict of interest. Maria Alejandra Asmar Murgas MD: declares that she has no conflict of interest. Abelardo Camacho Uribe MD: declares that he has no conflict of interest. Valeria Barrios MD: declares that she has no conflict of interest. Guillermo Bonilla León MD: has participated as paid speaker for Boehringer-Ingelheim, Pfizer, Sanofi and DePuy Synthes (Orthopedics); has received other financial support from DePuy Synthes (Orthopedics), has received research support from a company or supplier as a Principal researcher for Grunenthal and Johnson & Johnson, outside this work. Adolfo Llinás Volpe MD: has received royalties from Innomed, Novamed and 3 M; has participated as paid speaker for Zimmer, Shire, Novonordisk, Novartis, Johnson & Johnson, Medtronic and Procaps; has participated as paid consultant for Zimmer and Medtronic, outside this work.
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