The Impact of Patient Resiliency on Successful Same-Day Discharge and Postoperative Outcomes in Primary Total Hip and Knee Arthroplasty

Background: Total hip and knee arthroplasty rates in the outpatient setting continue to increase in the United States. Patient resiliency is one facet surgeons may consider when determining whether a patient would make a suitable candidate for same-day discharge. This study examined the relationship between resilience and success of same-day discharge in patients undergoing primary total hip and knee arthroplasty.

Methods: A retrospective review was conducted to examine the effects of preoperative resiliency scores (Pain Self-Efficacy Questionnaire Abbreviated 2-Item Form [PSEQ-2]) on same-day discharge rates and patient-reported outcome measures (PROMs) at three months and one year postoperatively. Data analyses utilized logistic regressions to evaluate the odds of same-day discharge (SDD) success with preoperative PSEQ-2 resiliency scores. Mixed linear models were utilized to evaluate the relationship between preoperative PSEQ-2 resiliency scores and postoperative PROMs.

Results: Of the cohort of 700 total knee arthroplasty (TKA) patients, after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery had significantly higher preoperative PSEQ-2 scores (P = 0.022). Of the cohort of 530 total hip arthroplasty (THA) patients, again after controlling for confounding factors such as age and body mass index (BMI), patients who were discharged home on the day of surgery trended towards significantly higher preoperative PSEQ-2 scores, although statistical significance was not reached (P = 0.058). There was a significant inverse relationship seen between preoperative PSEQ-2 scores and Global Mental Health scores at three months and one year postoperatively (P = 0.023). No other statistically significant relationships were seen between preoperative PSEQ-2 and the other PROMs.

Conclusions: Preoperative resiliency scores were significantly higher in patients undergoing primary total hip and knee arthroplasty that were discharged home on the day of surgery. Preoperative resiliency scores did not predict higher postoperative PROMs.