Comorbid Factors and Selection for Same-Day Total Joint Arthroplasty

Background: It is anticipated that the number of total joint arthroplasties (TJAs) performed worldwide will continue to increase. There is a significant cost to performing TJA. Health care providers must conscientiously work toward providing access and containing costs. There has been an interest in trying to select patients, who may be a candidate for same day discharge, or discharge within 23 hours. Preoperative medical optimization helps decrease intraoperative and postoperative complications. Purposes: Discuss exclusion criteria for which patients are not suitable for same day discharge or discharge within 23 hours. Methods: Available literature is used to support exclusion criteria. Results: Exclusion criteria may include: frailty, malnutrition, uncontrolled diabetes, chronic kidney disease stage 4 or 5, myocardial infarction within the last 6 months, active ischemia on cardiac testing, poorly controlled heart failure, significant valvular disease, hypertrophic cardiomyopathy, ongoing tobacco use, poorly controlled asthma or COPD, home oxygen dependence, known OSA (noncompliant with treatment), cirrhosis, bleeding disorder, anemia and expected to require transfusion, stroke within last 9 months, dementia, and substance abuse. Conclusion: Physicians must assess the complexity of the surgery and the patient’s comorbidities to decide whether the patient is a candidate for same day total joint arthroplasty.