Korean J Anesthesiol Search

CLOSE


Korean J Anesthesiol > Volume 74(1); 2021 > Article
Burton, Finneran, Angerstein, Ross, Mitchell, Waterman, Elsharydah, Said, and Gabriel: Demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty: a retrospective cohort study

Abstract

Background

Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. We examined demographic and clinical factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty in adult patients.

Methods

Utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database, we extracted information of all patients that underwent shoulder arthroplasty. The primary and secondary outcome of interest was same-day discharge and 30-day unplanned readmission, respectively. We utilized multivariable logistic regression to identify covariates associated with these outcomes.

Results

There were 17,011 patients analyzed when identifying predictors for same-day discharge. There was an increase in same-day discharge from 2007 to 2016. The odds of same-day discharge were significantly better for males (P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, chronic obstructive pulmonary disease, congestive heart failure (CHF), bleeding disorder, and comorbidity burden (all P < 0.001). There were 14,276 patients analyzed for hospital readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, CHF, bleeding disorder, and higher comorbidity burden (all P < 0.005).

Conclusions

The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge. Risk stratification, preoperative optimization, and coordinated care after surgery may be helpful to optimize patients for same-day discharge.

Introduction

Total shoulder arthroplasty (TSA) procedures have doubled in the United States over the past ten years [1]. With approximately 70,000 surgeries each year, TSA has become the fastest growing total joint replacement procedure in the United States [1,2]. The number of procedures is expected to further increase given the aging population and the notable success of TSA procedures in restoring function and reducing pain [3,4]. TSA procedures are used to treat various degenerative conditions of the shoulder common in older adult populations [4,5].
Facility utilization constitutes an additional modifiable aspect of overall cost for these procedures. Minimizing hospital length of stay has the potential to greatly reduce health care spending. Same-day discharge, defined as discharge from the hospital within 24 h of surgery, has been shown to be safe for joint arthroplasty. The objective of the present study was to evaluate demographic and clinical factors associated with same-day discharge among adult patients who underwent shoulder arthroplasty (total and hemiarthroplasty) using the American College of Surgeons National Quality Improvement Program (ACS NSQIP) database. A secondary objective was to identify risk factors for 30-day unplanned hospital readmission. 

Materials and Methods

Data registry

Our study was exempt from Institutional Review Board (IRB) approval and the requirement for written informed consent was waived. In the retrospective study, patient data was de-identified and exempt from consent requirements by our IRB. The ACS NSQIP registry was used to extract all patient records [6]. Briefly, ACS NSQIP is a nationally validated surgical outcomes registry used extensively to improve health outcomes. Inter-Rater Reliability Audit of chosen participating sites and other training methods are in place to ensure high quality data abstraction. NSQIP undergoes a systemic sampling process called the 8-day cycle, developed to make certain cases have an equal chance of being selected from each day of the week thereby preventing bias in choosing cases for assessment. The manuscript adheres to Enhancing the Quality and Transparency of Research (EQUATOR) guidelines.

Data collection

Cases were defined with Current Procedural Terminology code for shoulder arthroplasty 23472 (total shoulder arthroplasty) and 23470 (hemiarthroplasty). We used the ACS NSQIP database from 2007 to 2016 to evaluate risk factors associated with the primary outcome — same-day hospital discharge. However, ACS NSQIP from 2012 to 2016 was used to evaluate factors associated with the secondary outcome — unplanned readmission — defined as any unplanned readmission (to the same or another hospital) for a postoperative occurrence likely related to the principal surgical procedure within 30 days of surgery. We evaluated the association of the following covariates with the outcomes of interest: sex, body mass index (BMI), age, smoking status, steroid use, dyspnea, functional status, diabetes mellitus, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension (HTN), bleeding disorder, anesthesia type, secondary anesthesia type (regional anesthesia versus none), and American Society of Anesthesiologists (ASA) classification score. BMI categories were < 20 kg/m2, 20–24.9 kg/m2, 25–29.9 kg/m2, 30–39.9 kg/m2, 40–49.9 kg/m2, ≥ 50 kg/m2 (the reference group was those with BMI range 20–24.9 kg/m2).

Statistical analysis

R (version 3.3.2) was the statistical computing software used to perform all statistical analysis discussed in our study. Mean differences between patients with same-day discharge versus those without (and with unplanned admission versus without) were compared with the Pearson chi-square and student t-test. A multivariable logistic regression was used to evaluate the association of same-day discharge and unplanned readmission. We first performed univariable logistic regression for each covariate and assessed its association with the outcomes. The primary and secondary outcomes are reported as odds ratios. During the initial model building of the multivariable logistic regression analysis, we only included those covariates with an association with the outcome with a P value < 0.2 from the univariable analysis. Subsequently, backward selection with a P value threshold of < 0.05 was performed to derive the final multivariable model. Covariates included in this final model were then presented as risk factors associated with the outcome. The odds ratio (OR) with associated 95% CI is reported for each covariate.

Results

Same-day discharge

We identified 17,021 patients who underwent shoulder arthroplasty from 2007 to 2016. After removing 10 observations with missing length of hospital stay, the final analysis included 17,011 patients. Table 1 lists the study characteristics among the study population dividing the cohorts based on those with same-day discharge versus not. Fig. 1 demonstrates an increase in the prevalence of same-day discharge per year. On an unadjusted analysis, compared to the rate of non-same-day discharge, the rate of same-day discharge was significantly higher for males (36% vs. 53.9%, P < 0.001), overweight (31.1% vs. 33.5%, P < 0.001) and obese (38.2% vs. 41.4%, P < 0.001) patients, and ASA class ≤ 2 (38.6% vs. 55.2%, P < 0.001). Compared to the rate of non-same-day discharge, the rate of same-day discharge was significantly lower for those with non-insulin dependent (12.7% vs. 11.3%, P < 0.001) and insulin dependent (6.7% vs. 3.6%, P < 0.001) diabetes mellitus, dyspnea with moderate exertion (8.0% vs. 4.9%, P < 0.001) and dyspnea at rest (0.5% vs. 0.2%, P < 0.001), poor functional status (4.6% vs. 1.6%, P < 0.001), COPD (8.1% vs. 4.6%, P < 0.001), CHF (0.8% vs. 0.1%, P < 0.001), hypertension (69.4% vs. 62.3%, P < 0.001), bleeding disorder (3.5% vs. 1.9%, P < 0.001), and regional anesthesia (3.7% vs. 3.5%, P = 0.027). Fig. 1 shows the trends in same-day discharge.

30-day unplanned hospital readmission

To evaluate factors associated with unplanned readmission, we identified 14,276 patients who underwent shoulder arthroplasty from 2012 to 2016, who had available data regarding hospital readmission. Table 2 illustrates the study characteristics among the study population dividing the cohorts based on those with unplanned readmission versus not.
Fig. 2 illustrates the results of the multivariable logistic regression analysis of factors associated with unplanned readmission. The odds of unplanned readmission were significantly higher for every 10-year increase in age and for patients with poor functional status, CHF, bleeding disorder, and ASA class 3 and 4 (all P < 0.05).
Fig. 3 displays the results of the multivariable logistic regression analysis of factors associated with same-day discharge. The odds of same-day discharge were better for males (OR: 1.91, 95% CI: 1.79, 2.04, P < 0.001). The odds of same-day discharge was significantly decreased for every 10-year increase in age and for patients with insulin dependent diabetes, poor functional status, COPD, CHF, bleeding disorder, and ASA class 3 and 4 (all P < 0.001).

Discussion

We conducted a retrospective cohort analysis of factors associated with same-day hospital discharge and 30-day hospital readmission after shoulder arthroplasty using patient data from a nationally validated surgical outcomes registry. The odds of same-day discharge was lower for every 10-year increase in age and for patients with a medical history of insulin dependent diabetes, poor functional status, COPD, CHF, bleeding disorder, or ASA class 3 or 4. However, in this study, the odds of same-day discharge was significantly increased for male patients. Patients with comorbidities were also more likely to experience unplanned hospital readmission. Although ambulatory surgery is well established and safe for knee and hip arthroplasty [7], further work is needed to define and understand the risk of adverse outcomes and benefits of ambulatory surgery for shoulder arthroplasty.
Although shoulder arthroplasty is less commonly performed than knee and hip arthroplasty, the demand is projected to increase [8]. The annual procedure volume growth rate of total shoulder arthroplasty and hemiarthroplasty was 9.4% and 5.4%, respectively [8]. From 1993 to 2007, there has been roughly a 2-fold reduction in postoperative hospital length of stay due to improvements in surgical technique and prosthetic design, preoperative patient education, use of intraoperative anesthetics allowing for rapid recovery, and postoperative multimodal analgesia. However, costs associated with shoulder arthroplasty have steadily increased [810]. Identifying factors and designing interventions mitigating barriers to cost control is therefore important.
In 2017, United States health care spending grew by 3.9% and comprises roughly 18% of annual spending [11]. Same-day discharge has been identified as a potential opportunity to lower costs while improving patient satisfaction and quality of care for joint arthroplasty [12]. The recent demand for ambulatory surgery may be due to escalating health care costs, and implementing same-day surgery discharged protocols with multidisciplinary care teams may be cost-effective. Same-day discharge is becoming common practice in many medical specialties across academic surgery centers and hospitals. Ambulatory TSA has increased in response to advances in multimodal pain management, patient screening parameters, and efforts to reduce costs due to inpatient admission. Cost benefit analyses estimate that outpatient procedures can lead to savings of thousands of dollars per patient and millions of dollars over the next ten years [13,14]. Previous studies of ACS NSQIP and single institution data have retrospectively examined predictors of morbidity with same day TSA procedures [13,15,16]. These factors, such as CHF, hematocrit < 38%, BMI, and depression, allow physicians to screen for suitable candidates, further decreasing morbidity post-operatively. Current studies have found no significant differences in the complication rates between same day discharge and inpatient procedures in appropriately screened patients [14].
We identified several comorbidities that were associated with a decrease in same-day discharge. Not surprisingly, patients with insulin-dependent diabetes mellitus, poor functional status, COPD, CHF, bleeding disorders, or higher ASA class were less likely to be discharged on the same day as the surgery. Sher and colleagues show a higher prevalence of impaired functional status, history of pulmonary and cardiac disease, stroke, and ASA class ≥ 3 among patients who were not eligible for same-day discharge following total knee or hip arthroplasty [12]. Similarly, Basques and colleagues report that diabetes mellitus and older age were shown to be associated with higher rates of 30-day readmission following same-day discharger for joint arthroplasty [17]. While many of these conditions are chronic, patients may benefit from preoperative optimization and postoperative multidisciplinary coordinated care pathways.
If patients are candidates for same-day discharge, early physical therapy has been shown to reduce readmission rates among patients undergoing total joint arthroplasty [18], and may be beneficial in this surgical population. Gogineni et al. [19] report no differences in complications rates among patients who underwent outpatient versus inpatient surgery after implementing structured care pathways involving surgeons, anesthesiologists, case management, rehabilitation services, home care companies, hospital administrators, and nursing leaders. Life expectancy has increased in the United States and consequently chronic diseases have become more prevalent. We must counteract the deleterious impact of these chronic conditions by standardizing preoperative care and mobilizing multidisciplinary health teams.
Joint arthroplasty is more common among women, who also experience worse health outcomes compared to men [20]. In this study, the odds of same-day discharge was 86% higher for men compared to women. While the causes of this disparity are currently undefined, possible explanations include higher comorbidity burden in women, worse functional status, or other sociodemographic features that worsen outcomes. Further work is needed to substantiate our findings and provide insight into other contributing factors, with the ultimate aim to identify modifiable factors that may improve health outcomes and reduce health care spending.
ACS NSQIP is an excellent database source for evaluating outcomes in ambulatory surgery. However, ACS NSQIP does not include important perioperative variables that would allow for a more detailed and informative study such as cost associated with same-day versus non-same day discharge, severity of preoperative comorbidities, prosthesis used, surgeon’s experience, hospital volume, intraoperative anesthetic agents delivered, intraoperative variables (i.e., case duration and estimated blood loss), and pain management strategies. This retrospective study has limitations that are inherent to retrospective studies that include but are not limited to misclassification bias and confounding. Fortunately, since ACS NSQIP prospectively collects data, the temporal relationship between preoperative and postoperative variables is not ambiguous. Additionally, ACS NSQIP has program demands that may limit the participation of smaller community hospitals.
In conclusion, this is the first study to evaluate factors associated with same-day discharge and unplanned readmission following shoulder arthroplasty. The results of this study show that preoperative comorbidities and advanced age reduce the odds of same-day discharge and increase the odds of unplanned readmission. Risk stratification, preoperative optimization, and coordinated care after surgery may help to safely implement standardized protocols for same-day discharge. Enhanced care pathways may be helpful for patients who are candidates for same-day discharge.

NOTES

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Author Contributions

Brittany Burton (Conceptualization; Data curation; Methodology; Writing – original draft; Writing – review & editing)

John J. Finneran (Writing – review & editing)

Aaron Angerstein (Writing – review & editing)

Evelyn Ross (Writing – review & editing)

Ana Mitchell (Writing – review & editing)

Ruth S. Waterman (Writing – review & editing)

Ahmad Elsharydah (Writing – review & editing)

Engy T. Said (Writing – review & editing)

Rodney A. Gabriel (Conceptualization; Data curation; Formal analysis; Writing – original draft; Writing – review & editing)

Fig. 1.
Trends in same-day discharge.
kja-19471f1.jpg
Fig. 2.
Multivariable analysis of factors associated with unplanned readmission. CHF: congestive heart failure, ASA: American Society of Anesthesiologists.
kja-19471f2.jpg
Fig. 3.
Multivariable analysis of factors associated with unplanned readmission. COPD: chronic obstructive pulmonary disease, CHF: congestive heart failure, ASA: American Society of Anesthesiologists.
kja-19471f3.jpg
Table 1.
Study Characteristics
Patient factors Same-day discharge
No (n = 9,367) Yes (n = 7,644) P value
Male 3367 (36.0) 4120 (53.9) < 0.001
Age 70.24 ± 10.36 66.67 ± 10.49 < 0.001
 18–29 13 (0.1) 35 (0.5)
 30–39 65 (0.7) 102 (1.3)
 40–49 238 (2.5) 293 (3.8)
 50–69 1031 (11.0) 1249 (16.3)
 60–69 2815 (30.1) 2781 (36.4)
 > 70 5205 (55.6) 3184 (41.7)
BMI < 0.001
 < 20 229 (2.4) 106 (1.4)
 20–24.9 1486 (15.9) 1097 (14.4)
 25–29.9 2914 (31.1) 2561 (33.5)
 30–39.9 3580 (38.2) 3167 (41.4)
 40–49.9 905 (9.7) 601 (7.9)
 ≥ 50 158 (1.7) 89 (1.2)
 Unknown 95 (1.0) 23 (0.3)
DM < 0.001
 No 7545 (80.5) 6504 (85.1)
 Non-insulin dependent 1192 (12.7) 866 (11.3)
 Insulin dependent 630 (6.7) 274 (3.6)
Smoker 985 (10.5) 927 (12.1) 0.001
Dyspnea < 0.001
 No 8570 (91.5) 7259 (95.0)
 Moderate exertion 751 (8.0) 371 (4.9)
 At rest 46 (0.5) 14 (0.2)
Functional status < 0.001
 Independent 8878 (94.8) 7473 (97.8)
 Poor 430 (4.6) 121 (1.6)
 Unknown 59 (0.6) 50 (0.7)
COPD 755 (8.1) 350 (4.6) < 0.001
CHF 73 (0.8) 10 (0.1) < 0.001
HTN 6497 (69.4) 4759 (62.3) < 0.001
Bleeding disorder 326 (3.5) 142 (1.9) < 0.001
Primary anesthesia 0.027
 General 9008 (96.2) 7347 (96.1)
 Regional 343 (3.7) 268 (3.5)
 Unknown 16 (0.2) 29 (0.4)
Additional anesthesia < 0.001
 Yes 2931 (31.3) 2905 (38.0)
 No 2437 (26.0) 2562 (33.5)
 Unknown 3994 (42.7) 2175 (28.5)
ASA class < 0.001
 1 & 2 Mild disturbance 3616 (38.6) 4216 (55.2)
 3 Severe disturbance 5367 (57.3) 3301 (43.2)
 > 4 Life threatening disturbance 374 (4.0) 117 (1.5)
 Unknown 10 (0.1) 10 (0.1)

Values are presented as number of patients (%) or mean ± SD. BMI: body mass index, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, CHF: congestive heart failure, HTN: hypertension, ASA: American Society of Anesthesiologists.

Table 2.
Study Characteristics
Patient factors Unplanned readmission
No (n = 13,860) Yes (n = 416) P value
Male 6124 (44.2) 181 (43.5) 0.823
Age 68.70 ± 10.24 71.09 ± 11.09 < 0.001
 18–29 25 (0.2) 1 (0.2)
 30–39 117 (0.8) 3 (0.7)
 40–49 381 (2.7) 11 (2.6)
 50–69 1823 (13.2) 44 (10.6)
 60–69 4720 (34.1) 116 (27.9)
 > 70 6794 (49.0) 241 (57.9)
BMI 0.571
 < 20 262 (1.9) 9 (2.2)
 20–24.9 2041 (14.7) 68 (16.3)
 25–29.9 4434 (32.0) 127 (30.5)
 30–39.9 5571 (40.2) 156 (37.5)
 40–49.9 1258 (9.1) 45 (10.8)
 ≥ 50 202 (1.5) 9 (2.2)
 Unknown 92 (0.7) 2 (0.5)
DM 0.001
 No 11433 (82.5) 317 (76.2)
 Non-insulin dependent 1699 (12.3) 61 (14.7)
 Insulin dependent 728 (5.3) 38 (9.1)
Smoker 1569 (11.3) 54 (13.0) 0.331
Dyspnea 0.001
 No 12988 (93.7) 372 (89.4)
 Moderate exertion 830 (6.0) 43 (10.3)
 At rest 42 (0.3) 1 (0.2)
Functional status < 0.001
 Independent 13407 (96.7) 373 (89.7)
 Poor 358 (2.6) 39 (9.4)
 Unknown 95 (0.7) 4 (1.0)
COPD 896 (6.5) 52 (12.5) < 0.001
CHF 63 (0.5) 11 (2.6) < 0.001
HTN 9130 (65.9) 308 (74.0) 0.001
Bleeding disorder 369 (2.7) 29 (7.0) < 0.001
Primary anesthesia 0.895
 General 13333 (96.2) 402 (96.6)
 Regional 485 (3.5) 13 (3.1)
 Unknown 42 (0.3) 1 (0.2)
Additional anesthesia 0.774
 Yes 5659 (40.9) 177 (42.5)
 No 4856 (35.1) 143 (34.4)
 Unknown 3338 (24.1) 96 (23.1)
ASA class < 0.001
 1 & 2 Mild disturbance 6356 (45.9) 118 (28.4)
 3 Severe disturbance 7102 (51.2) 259 (62.3)
 > 4 Life threatening disturbance 386 (2.8) 39 (9.4)
 Unknown 16 (0.1) 0 (0.0)
Reoperation 62 (0.4) 131 (31.5) < 0.001

Values are presented as number of patients (%) or mean ± SD. BMI: body mass index, DM: diabetes mellitus, COPD: chronic obstructive pulmonary disease, CHF: congestive heart failure, HTN: hypertension, ASA: American Society of Anesthesiologists.

References

1. Bullock GS, Garrigues GE, Ledbetter L, Kennedy J. A systematic review of proposed rehabilitation guidelines following anatomic and reverse shoulder arthroplasty. J Orthop Sports Phys Ther 2019; 49: 337-46.
crossref pmid
2. Chapman RM, Torchia MT, Bell JE, Van Citters DW. Continuously monitoring shoulder motion after total shoulder arthroplasty: maximum elevation and time spent above 90° of elevation are critical metrics to monitor. J Shoulder Elbow Surg 2019; 28: 1505-14.
crossref pmid pmc
3. Floyd SB, Chapman CG, Thigpen CA, Brooks JM, Hawkins RJ, Tokish JM. Shoulder arthroplasty in the US Medicare population: a 1-year evaluation of surgical complications, hospital admissions, and revision surgery. JSES Open Access 2018; 2: 40-7.
crossref pmid pmc
4. Koh J, Galvin JW, Sing DC, Curry EJ, Li X. Thirty-day complications and readmission rates in elderly patients after shoulder arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2018; 2: e068.
crossref pmid pmc
5. Simovitch RW, Friedman RJ, Cheung EV, Flurin PH, Wright T, Zuckerman JD, et al. Rate of improvement in clinical outcomes with anatomic and reverse total shoulder arthroplasty. J Bone Joint Surg Am 2017; 99: 1801-11.
crossref pmid
6. American College of Surgeons National Surgical Quality Improvement Program. ACS NSQIP participant use data file [Internet]. Chicago: ACS NSQIP [cited 2019 Dec 7]. Available from https://www.facs.org/quality-programs/acs-nsqip/participant-use

7. Hoeffel DP, Daly PJ, Kelly BJ, Giveans MR. Outcomes of the first 1,000 total hip and total knee arthroplasties at a same-day surgery center using a rapid-recovery protocol. J Am Acad Orthop Surg Glob Res Rev 2019; 3: e022.
crossref pmid pmc
8. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg 2010; 19: 1115-20.
crossref pmid
9. Amundson AW, Panchamia JK, Jacob AK. Anesthesia for same-day total joint replacement. Anesthesiol Clin 2019; 37: 251-64.
crossref pmid
10. Bean BA, Connor PM, Schiffern SC, Hamid N. Outpatient shoulder arthroplasty at an ambulatory surgery center using a multimodal pain management approach. J Am Acad Orthop Surg Glob Res Rev 2018; 2: e064.
crossref pmid pmc
11. Centers for Medicare and Medicaid Services. National health expenditure data [Internet]. Baltimore: CMS [updated 2020 Dec 16, cited 2019 Dec 17] Available from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html

12. Sher A, Keswani A, Yao DH, Anderson M, Koenig K, Moucha CS. Predictors of same-day discharge in primary total joint arthroplasty patients and risk factors for post-discharge complications. J Arthroplasty 2017; 32: S150-6.
crossref pmid
13. Brolin TJ, Throckmorton TW. Outpatient shoulder arthroplasty. Orthop Clin North Am 2018; 49: 73-9.
crossref pmid
14. Brolin TJ, Mulligan RP, Azar FM, Throckmorton TW. Neer Award 2016: outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study. J Shoulder Elbow Surg 2017; 26: 204-8.
crossref pmid
15. Brolin TJ, Cox RM, Zmistowski BM, Namdari S, Williams GR, Abboud JA. Surgeons’ experience and perceived barriers with outpatient shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27: S82-7.
crossref pmid
16. Anthony CA, Westermann RW, Gao Y, Pugely AJ, Wolf BR, Hettrich CM. What are risk factors for 30-day morbidity and transfusion in total shoulder arthroplasty? A Review of 1922 Cases. Clin Orthop Relat Res 2015; 473: 2099-105.
crossref pmid
17. Basques BA, Tetreault MW, Della Valle CJ. Same-day discharge compared with inpatient hospitalization following hip and knee arthroplasty. J Bone Joint Surg Am 2017; 99: 1969-77.
crossref pmid
18. Warwick H, George A, Howell C, Green C, Seyler TM, Jiranek WA. Immediate physical therapy following total joint arthroplasty: barriers and impact on short-term outcomes. Adv Orthop 2019; 2019: 6051476.
crossref pdf
19. Gogineni HC, Gray CF, Prieto HA, Deen JT, Boezaart AP, Parvataneni HK. Transition to outpatient total hip and knee arthroplasty: experience at an academic tertiary care center. Arthroplast Today 2018; 5: 100-5.
crossref pmid
20. Kim KY, Anoushiravani AA, Elbuluk A, Chen K, Davidovitch R, Schwarzkopf R. Primary total hip arthroplasty with same-day discharge: who failed and why. Orthopedics 2018; 41: 35-42.
crossref pmid


ABOUT
ARTICLE CATEGORY

Browse all articles >

BROWSE ARTICLES
AUTHOR INFORMATION
Editorial Office
101-3503, Lotte Castle President, 109 Mapo-daero, Mapo-gu, Seoul 04146, Korea
Tel: +82-2-792-5128    Fax: +82-2-792-4089    E-mail: journal@anesthesia.or.kr                

Copyright © 2022 by Korean Society of Anesthesiologists.

Developed in M2PI

Close layer
prev next