Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup : A Danish cohort study of 6718 procedures from a fast-track multi-center collaboration.
13 affiliations
- 1Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark. [email protected].
- 2Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark. [email protected].
- 3Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark.
- 4Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Svendborg, Odense, Denmark.
- 5Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Vejle, Denmark.
- 6Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
- 7Department of Orthopaedic Surgery, Copenhagen University Hospital Herlev-Gentofte, Gentofte, Denmark.
- 8Department of Orthopaedic Surgery, Næstved, Slagelse and Ringsted Hospitals, Næstved, Denmark.
- 9Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
- 10Department of Anaesthesia, Hospital of Northern Zeeland, Hillerød, Hillerød, Denmark.
- 11Section of Surgical Pathophysiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- 12Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark. [email protected].
- 13Center for Fast-track Hip and Knee Replacement, Copenhagen, Denmark. [email protected].
Abstract
Background
Day-case hip and knee arthroplasty can reduce bed occupancy and improve cost-effectiveness, which is crucial for addressing the increasing demand among hip and knee osteoarthritis patients. This study investigated how different arthroplasty center setups were associated with the implementation and day-of-surgery (DOS) discharge rates of a standardized day-case setup.Materials and methods
We included unilateral primary hip and knee arthroplasty patients from seven fast-track arthroplasty centers, all implementing a standardized day-case setup in September 2022 with identical eligibility and discharge criteria. Centers were categorized as: Satellite Arthroplasty Centers (SACs): Only primary arthroplasties, separate logistics. Elective Arthroplasty Centers (EACs): Complex primaries, revisions, separate logistics. Arthroplasty Unit Orthopedic Departments (AUOs): Primary and revision procedures, integrated into a general orthopedic department. We compared DOS discharge rates from September 2022 to September 2023 with a baseline period (July 2019-December 2019) using crude percentages. We compared the DOS discharge rate for day-case-eligible patients in study period between the center types using mixed effects models.Results
We included 6718 patients (1357 SAC, 4309 EAC, 1052 AUO) during the study period and 3974 in the baseline period. DOS discharge rates increased post-implementation across all centers (SAC: 3.9% to 30%, EAC: 5.5% to 23%, AUO: 7.4% to 14%). Compared with AUOs (36%), successful DOS discharge among eligible patients was more likely in SACs (54%; adjusted OR 3.0, 95% CI 1.3-7.1; adjusted risk difference 25 percentage points, 95% CI 5.9-44) and EACs (60%; adjusted OR 3.8, 95% CI 1.7-8.5; adjusted risk difference 31 percentage points, 95% CI 13.8-48).Conclusions
Arthroplasty centers with logistics separate from the general orthopedic department, SACs and EACs, were associated with higher rates of successful DOS discharge among eligible patients during implementation of a standardized day-case pathway, despite integrated arthroplasty units, AUOs, having higher day-case surgery use before implementation.
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BibTeX
@article{jensen2026arthroplasty,
title = {{Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup : A Danish cohort study of 6718 procedures from a fast-track multi-center collaboration.}},
author = {Christian Bredgaard Jensen and Oddrún Danielsen and Claus Varnum and Thomas Jakobsen and Mikkel Ratsach Andersen and Manuel Josef Bieder and Søren Overgaard and Christoffer Calov Jørgensen and Henrik Kehlet and Kirill Gromov},
journal = {Archives of orthopaedic and trauma surgery},
year = {2026},
month = oct,
doi = {10.1007/s00402-026-06525-8},
url = {https://europepmc.org/article/MED/42955362},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Arthroplasty centers logistically separated from general orthopedic departments were associated with a more successful implementation of a standardized day-case setup : A Danish cohort study of 6718 procedures from a fast-track multi-center collaboration.
AU - Christian Bredgaard Jensen
AU - Oddrún Danielsen
AU - Claus Varnum
AU - Thomas Jakobsen
AU - Mikkel Ratsach Andersen
AU - Manuel Josef Bieder
AU - Søren Overgaard
AU - Christoffer Calov Jørgensen
AU - Henrik Kehlet
AU - Kirill Gromov
PY - 2026
DA - 2026/10/29
JO - Archives of orthopaedic and trauma surgery
DO - 10.1007/s00402-026-06525-8
UR - https://europepmc.org/article/MED/42955362
AB - Background Day-case hip and knee arthroplasty can reduce bed occupancy and improve cost-effectiveness, which is crucial for addressing the increasing demand among hip and knee osteoarthritis patients. This study investigated how different arthroplasty center setups were associated with the implementation and day-of-surgery (DOS) discharge rates of a standardized day-case setup.Materials and methods We included unilateral primary hip and knee arthroplasty patients from seven fast-track arthroplasty centers, all implementing a standardized day-case setup in September 2022 with identical eligibility and discharge criteria. Centers were categorized as: Satellite Arthroplasty Centers (SACs): Only primary arthroplasties, separate logistics. Elective Arthroplasty Centers (EACs): Complex primaries, revisions, separate logistics. Arthroplasty Unit Orthopedic Departments (AUOs): Primary and revision procedures, integrated into a general orthopedic department. We compared DOS discharge rates from September 2022 to September 2023 with a baseline period (July 2019-December 2019) using crude percentages. We compared the DOS discharge rate for day-case-eligible patients in study period between the center types using mixed effects models.Results We included 6718 patients (1357 SAC, 4309 EAC, 1052 AUO) during the study period and 3974 in the baseline period. DOS discharge rates increased post-implementation across all centers (SAC: 3.9% to 30%, EAC: 5.5% to 23%, AUO: 7.4% to 14%). Compared with AUOs (36%), successful DOS discharge among eligible patients was more likely in SACs (54%; adjusted OR 3.0, 95% CI 1.3-7.1; adjusted risk difference 25 percentage points, 95% CI 5.9-44) and EACs (60%; adjusted OR 3.8, 95% CI 1.7-8.5; adjusted risk difference 31 percentage points, 95% CI 13.8-48).Conclusions Arthroplasty centers with logistics separate from the general orthopedic department, SACs and EACs, were associated with higher rates of successful DOS discharge among eligible patients during implementation of a standardized day-case pathway, despite integrated arthroplasty units, AUOs, having higher day-case surgery use before implementation.
SN - 0936-8051
SN - 1434-3916
ER -