Same-Day TJA Found Safe for Patients With History of AF

Same-day discharge after joint replacement surgery is feasible in patients with a history of atrial fibrillation (AF), according to a study presented at the American Academy of Orthopaedic Surgeons 2src25 Annual meeting.

AF is known to be a risk factor for perioperative complications, including thromboembolic events, after total joint arthroplasty (TJA), few data exist regarding the feasibility of same-day surgery in this patient population. Coupled with the increasing popularity of outpatient joint replacement, the researchers “wanted to ensure that we are continuing to provide appropriate care for patients and not put them at increased risk of complications with early discharges,” said Nader A. Nassif, MD, chief of joint replacements at the Hoag Orthopedic Institute in Irvine, California.

“We looked at our patients with known atrial fibrillation, who we typically kept overnight, and asked ourselves if those overnight stays added any benefit to their outcomes.”

Nassif and his colleagues’ study looked at a cohort of patients with TJA with AF and compared them with those without diagnosed arrhythmias who were discharged the same day. Outcomes of interest were visits to the emergency department, readmissions to the hospital, and cardiac events.

Nassif and his colleagues reviewed their institution’s prospective joint registry to identify all total hip and total knee arthroplasties performed between January 2src19 and June 2src23. Patients were stratified into one of two cohorts: Those with a history of AF admitted as inpatients, and those with no history of AF who were discharged on the day of surgery. After 1:1 propensity score matching, there were 761 patients in each cohort.

A preoperative diagnosis of AF was not a significant predictor of visits to the emergency department: 1.71% of inpatients with TJA with a history of AF visited the emergency department within 72 hours of surgery vs src.79% of outpatients without a history of AF (P =.115).

Similarly, the rate of visits to the emergency department within 7 days was 1.97% among inpatients with a history of AF vs 1.84% among outpatients with no history of the condition (P =.851).

On the other hand, inpatients with AF were much more likely to be readmitted to the hospital within 3src days than those without the arrhythmia (3.42% vs src.45%; P <.srcsrc1).

“This is consistent with previous literature,” Nassif noted. “However, this finding does not impact the specific question asked by this paper regarding the safety of same-day discharge, which represents a much shorter timeline after discharge.”

Finally, the investigation found that a preoperative diagnosis of AF was not a significant predictor of cardiac events in the first 24 hours after surgery (P =.965).

Alexander Sah, MD, co-director of the Institute for Joint Restoration and Research at Washington Hospital in Fremont, California, called the new data “very reassuring” for joint surgeons who perform same-day procedures.

“A lot of people have atrial fibrillation and don’t even know it,” Sah said. A 2src18 study found roughly 13% of cases of AF in the United States are undiagnosed. “What’s more, surgery itself can often kick people into a-fib [atrial fibrillation], whether they’ve had it before or not,” he said.

Sah stressed that the goal of any surgery should be the patient’s well-being, not the speed with which they are discharged from the hospital.

“Even though people are recovering faster and going home within hours, we’re still using a saw, hammer, and drill on them,” he said. “As such, and we need to make sure they are having the best possible outcome; that’s still the bottom line. Success doesn’t come with getting people home the same day; success comes with having a good, long-lasting joint replacement with an uncomplicated recovery.”

No external funding was noted. Nassif and Sah reported no financial conflicts of interest.

Michael Vlessides is a best-selling author, personal biographer, and medical journalis