The current status of daycase hip and knee arthroplasty within the English National Health Service: a retrospective analysis of hospital episode statistics data.

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A high volume of total hip, total knee and unicompartmental knee arthroplasty procedures, an ageing population and continuing financial pressures within the English NHS mean that strategies to reduce length of hospital stay are attractive. Enhanced recovery after surgery protocols are one such intervention, and have advanced so that daycase arthroplasty is now possible. This study examines the current rate of daycase arthroplasty within the English NHS.Hospital episode statistics data from all English NHS providers of arthroplasty procedures were analysed. Activity, daycase rate, length of stay and readmission rates were recorded. All total hip, knee and unicompartmental knee operations undertaken within the time period 1 July 2018 to 30 June 2019 were examined.Length of stay was analysed for 162,966 patients; 74,665 (46%) were total hip arthroplasty, 79,252 (49%) were total knee arthroplasty and 9,049 were unicompartmental knee arthroplasty (5%). Mean length of stay was 4.08 days for total hip, 4.11 days for total knee and 2.64 days for unicompartmental knee arthroplasties. Daycase rate for total hip arthroplasty was 0.55%, 0.52% for total knee arthroplasty and 5.44% for unicompartmental knee arthroplasty. The percentage of patients staying in hospital for longer than four days (a length of stay of five days or more) was 18.61% of total hip arthroplasty spells, 20.54% of total knee arthroplasty spells and 5.48% of unicompartmental knee arthroplasty spells.This large observational study of unselected patients undergoing hip and knee arthroplasty demonstrates that the national daycase rate for arthroplasty across providers in the NHS is low. Mean length of stay remains higher than selected international comparators.

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Authors: T W Wainwright