Risk factors associated with the failure of day surgery for total knee arthroplasty a multivariate logistic regression analysis

TL;DR

This study identifies risk factors for delayed discharge after day surgery for total knee arthroplasty to help improve patient selection and surgical planning.

Contribution

The study identifies independent risk factors for delayed discharge using multivariate logistic regression analysis in day surgery for total knee arthroplasty.

Findings

Disease duration, knee flexion range of motion, glomerular filtration rate, and surgery time are independent risk factors for delayed discharge.

Patients with disease duration over 8 years and low glomerular filtration rate may not be suitable for day surgery.

Shortening surgery time and improving preoperative planning can reduce the risk of delayed discharge.

Abstract

To explore and analyze the risk factors leading to delayed discharge in patients undergoing day surgery for total knee arthroplasty, providing a theoretical basis for optimizing patient selection, targeted interventions, and managing expectations and risks of day surgery patients.

A retrospective analysis of clinical data from patients diagnosed with “knee osteoarthritis” and scheduled for day surgery for total knee arthroplasty at the Department of Orthopedics, Guizhou Provincial People's Hospital from October 2021 to June 2023. Patients were divided into a normal discharge group and a delayed discharge group based on whether their hospital stay exceeded 48 h. Univariate analysis and multivariate logistic regression analysis were used to identify potential risk factors between the two groups.

Among the 233 patients scheduled for day surgery for total knee arthroplasty, 82 experienced delayed discharge. Univariate analysis showed that age (P = 0.042), glomerular filtration rate (P = 0.011), diabetes history (P = 0.046), disease duration (P = 0.012), knee flexion range of motion (P < 0.001), knee flexion contracture degree (P = 0.006), and surgery time (P = 0.002) had statistically significant differences between the two groups. Multivariate logistic regression analysis revealed that disease duration (P = 0.017), knee flexion range of motion (P < 0.001), glomerular filtration rate (P = 0.010), and surgery time (P = 0.020) were independent risk factors. Additionally, postoperative motor function decline or sensory impairment, pain, dizziness or orthostatic hypotension, postoperative limb swelling, postoperative nausea and vomiting, bleeding and exudation, and psychosocial factors were the main reasons for delayed discharge.

Our study found that disease duration, knee flexion range of motion, glomerular filtration rate, and surgery time are independent risk factors for delayed discharge after day surgery for total knee arthroplasty. Patients with a disease duration of more than 8 years, preoperative flexion range of motion less than 90°, and low estimated glomerular filtration rate may not be suitable for day surgery for total knee arthroplasty. Surgeons should make adequate preoperative preparations and plans, refine surgical skills, and shorten surgery time under the premise of ensuring surgical effects to reduce the risk of postoperative delayed discharge.

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