Bone and Joint Institute

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Canadian Journal of Surgery





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© 2019 Joule Inc. or its licensors. Background: A substantial portion of the cost of total knee arthroplasty (TKA) results from the postoperative inpatient length of stay (LOS). Considering the annual increase in TKAs, reducing LOS represents a potential for cost savings. We sought to compare in-hospital costs and patient-reported outcomes for an early discharge protocol compared with the standard LOS following TKA. Methods: We conducted a retrospective matched cohort study, matching patients on age, sex, body mass index and preoperative Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score. We compared costs associated with time in the operating room, intraoperative pain control and inpatient stay as well as 1-year postoperative patient-reported outcomes between early discharge and standard LOS groups. Results: We included 50 patients in our study (25 per group). The average LOS in the early discharge group was 26.5 hours, compared with 48.9 hours in the standard care group. The early discharge group had higher intraoperative costs associated with pain control (mean difference 26.98, 95% confidence interval 14.41-37.90, p < 0.01); however, this difference was offset by substantial savings associated with the reduced LOS. The mean total cost for the early discharge group was $649.62 ± $281.71 versus $1279.71 ± $515.98 for the standard care group. There were no significant differences in SF12 or WOMAC scores between groups at 1 year postoperative. Conclusion: In-hospital costs were significantly lower with a postoperative day 1 discharge protocol than with standard LOS following TKA, with no difference in patient-reported outcomes.


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The article as originally published can be found as:

Marsh, J., Somerville, L., Howard, J. L. & Lanting, B. A. (2019). Significant cost savings and similar patient outcomes associated with early discharge following total knee arthroplasty. Can J Surg 2019; 62(1): 20-24. DOI: 10.1503/cjs.002118

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