Outpatient same-day discharge (SDD) after primary total hip (THA) and total knee arthroplasty (TKA) has rapidly evolved from a niche clinical experiment into the structural “new reality” of modern American orthopedics. Fueled by highly standardized multimodal pain management, preemptive local nerve blocks, and compressed anesthesia durations, sending a patient home a few hours after a total joint reconstruction is an exceptional clinical feat.
However, as commercial and public payors aggressively push a larger volume of primary joint replacements out of traditional inpatient beds, an alarming performance gap has materialized. Across the United States, data reveal that anywhere from 7% to 49% of patients who are formally scheduled for a same-day pathway end up failing discharge milestones, triggering an accidental, uncompensated hospital overnight stay.
