Day of Surgery Affects Length of Hospitalization for Patients Undergoing Total Joint Arthroplasty Discharged to Extended Care Facilities

Although the average hospital length of stay (LOS) after total joint arthroplasty (TJA) has decreased during the past 10 years, it continues to play a significant role in postoperative costs. The purpose of this study was to determine the effect of surgical day of the week on hospital LOS among TJA patients discharged to an extended care facility (ECF). A TJA database from a single hospital was used to identify all patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) between January 2013 and December 2016. Inclusion criteria were age older than 50 years, surgery Monday through Friday, and discharge to an ECF. A total of 2184 patients met inclusion criteria. Patients were divided into groups based on surgical day of the week. There was no statistically significant difference in age ( P =.120), sex ( P =.959), or procedure (TKA vs THA, P =.395) between groups based on surgery day. The LOS varied significantly by the day of the week ( P <.001). Thursday varied significantly from every other day of the week ( P <.001), with the greatest LOS (mean, 3.56±0.84 days) and the highest percentage of patients discharged (27.8%) compared with all other days. Tuesday had the shortest LOS (mean, 3.25±0.70 days) and differed significantly from Thursday and Friday ( P <.05). Patients discharged to an ECF after primary TKA and THA have an increased mean hospital LOS when their surgery falls on a Thursday. The authors recommend preferentially scheduling patients with planned postoperative discharge to an ECF for surgery on Tuesday and avoiding surgery on Thursday. [ Orthopedics. 2018; 41(2):82–86.]