Incidence of 30 Day Return to Hospital Following Same Day Discharge Total Hip Arthroplasty
Conditions: Osteoarthritis, Hip, Arthroplasty Complications, Complication of Surgical Procedure, Perioperative Complication
Sponsor: University of British Columbia

 
 
 
 
 
 
 
 
Incidence of 30 Day Return to Hospital 
Following Same Day Discharge Total Hip 
Arthroplasty 
 
- Study Protocol - 
 
 
Donald J Young, MD, FRCPC 
VGH/UBCH Dept of Anesthesiology & Perioperative Care 
Vancouver General Hospital & UBC Hospital 
Vancouver, BC, Canada 
 
Sept 23, 2019 
 
Version Date: Sept 23, 2019
Page 1 of 5 

 
Incidence of 30 Day Return to Hospital Following Same Day Discharge Total Hip Arthroplasty 
 
 
BACKGROUND: 
Same day discharge of primary total hip arthroplasty patients is becoming common in 
many large hospitals in Canada & the USA.​1​  At VGH/UBCH in 2017/18, a multidisciplinary 
committee was struck to create criteria for a same day discharge program at our hospital.  
Despite the practice of same day discharge for hip arthroplasty becoming more prevalent 
across the country, there is a lack of specific evidence based criteria to establish which patients 
would be safe to be sent home same-day, and which should remain in hospital for a minimum of 
one over night stay.​2​  With the input of various clinicians, the multidisciplinary committee 
established an objective set of criteria that would establish patient eligibility for same-day 
discharge following primary hip arthroplasty at our institution.​3​  The program came to be known 
as the Short Term Accelerated Recovery (STAR) program and has been running since Oct 15, 
2018.  
The process for STAR enrollment begins with the attending surgeon earmarking the 
patient as potentially STAR eligible at the time of surgical booking.  Following this, the patient is 
assessed by both Physiotherapy and Anesthesiology for eligibility to be a same day discharge 
or “STAR Patient”.  The criteria set by Anesthesiology is a document included with this 
submission.  At the time of this submission, 78 patients have been enrolled as STAR Patients. 
Of these, 35 patients were deemed ineligible for STAR due to not fulfilling the preop criteria.  Of 
the remaining 42 patients, 24 were discharged home same-day, and 19 were not able to be 
discharged home same-day due to perioperative issues on the day of surgery.  
A failing of the program has been the lack of follow up with patients to know whether any 
complications or returns to hospital occurred during the first 30 days after surgery.  
 
OBJECTIVE: 
As a Quality Assurance measure of safety for this program, we wish to know the rate of 
return to hospital for surgical related problems that occurred in this cohort in the first 30 days 
following surgery.  Amongst the patients initially enrolled as STAR patients (presently 78 
patients) we wish to compare the rate of return to hospital between those patients who were 
discharged the day of their surgery to those who spent at least their first night after surgery in 
hospital.  Our objective is to see how the rates of return to hospital for surgical related 
complications or issues compares between those who went home same day as their surgery 
and those who didn’t.  
 
METHODS: 
 
Study Design​:  
This project is a retrospective cohort quality assurance study.  Given that the criteria for 
enrollment in STAR is site specific and has not been established before, this project is designed 
to be a preliminary safety assessment that could inform future prospective studies on the 
Version Date: Sept 23, 2019
Page 2 of 5 

program’s safety and inform the potential sample sizes needed for such studies.   As well, the 
study would also expose the potential for a higher than expected return to hospital for same day 
discharge patients which may not otherwise have been known.  
The ​Primary Goal​ is to discern how many same day discharge patients had return to 
hospital encounters during the first 30 days post surgery, and to compare this rate to that of 
patients who were not discharged on the same day as surgery.  
Secondary Goals​ will be to compare return to hospital encounters within the first 7 days 
post surgery, as well as to compare and contrast the age and gender demographics of the 
cohorts studied.  
 
Patient Recruitment & Data Sources​:  
A list of all patients enrolled in the STAR Process is retained by the PI.  Research 
Personnel will use this list to review STAR Patient’s charts.  This will include both the paper 
chart records at VGH and UBCH, as well as the BC Care Connect provincial online charts. 
Patients enrolled in STAR need to live within one hours drive of VGH and are instructed to 
return to the VGH Emergency Room if they have surgical related concerns after surgery. 
Nonetheless, patients living in the surrounding areas that are within an hour of VGH (eg. 
Burnaby or Surrey) may have occasion to visit their local hospital rather than return to VGH.  It 
is for this reason that the BC Care Connect network will be accessed for each patient to see if 
any hospital encounters other than at VGH occurred during the first 30 days after surgery.  
The chart records will be reviewed specifically looking for post surgical hospital 
encounters up to 30 days post hip arthroplasty.  If a post surgical encounter is found on record, 
the nature of the encounter within the chart will be explored to discern whether the encounter 
was for a surgical related problem.  If a post surgical encounter is found, data collected about 
this encounter will include the nature of the problem and how many days postop the encounter 
occurred.  Sources of information for this data collection will be entirely by chart review.  There 
will be NO patient contacts made for the purpose of data substantiation.  
 
Inclusion Criteria​:  
All patients initially identified by their surgeon as potentially STAR eligible (this occurring 
prior to both Physiotherapy and Anesthesiology STAR assessments) are eligible as data 
sources in this study.  
 
Exclusion Criteria​:  
It is possible that a STAR eligible patient may not ever have come to surgery.  Such 
patients would be excluded from the study as all patients have to have had a surgical procedure 
performed to be included.  
 
Number of Patients​:  
As the specific criteria to be a STAR Patient at VGH/UBCH is new and not formerly used 
elsewhere, it is unknown how many patients would be needed to show a statistically significant 
difference between the two groups.  Indeed, one of the main purposes of this study is to act as a 
Version Date: Sept 23, 2019
Page 3 of 5 

preliminary indicator for the rate of return to hospital of such patients to inform a future 
prospective study’s appropriate sample size.  
To this end, we anticipate that up to 120 patients will have been through the STAR 
screening process by Oct 1, 2019 and that this should allow ample opportunity to compare the 
two groups.  
 
De-identification & Data Management​: 
Each patient’s personal identifiers (Name & Date of Birth) will be linked to a Patient 
Study Number.  The matching of personal identifiers to a Patient Study Number will occur only 
on one list, retained only by the PI and separate to all other data collection spreadsheets.  Data 
collected to fulfill the Primary and Secondary Outcomes will only contain the Patient Study 
Numbers, with no personal identifiers.  The personal identifiers will be used by study personnel 
to attain the patient’s paper VGH/UBCH charts, as well as being the source to the patient’s BC 
Care Connect chart.  We reiterate that none of the these personal identifiers will appear on any 
of the Primary & Secondary Outcomes data collection spreadsheets.  
Data linking the patient’s personal identifiers and the Patient Study Numbers will be 
retained only by the PI.  This linked data will be stored only on a password protected personal 
computer hard drive retained by the PI, and will not be stored on any “Cloud” or “off site” Server. 
Neither will it be shared electronically with any of the study personnel.  Paper copies of the 
linked data will be handed directly to Study Personnel by the PI for the purpose of data 
collection.  These paper copies will be destroyed once the data collection is completed by Study 
Personnel.  
Deidentified data will be collected onto a spreadsheet and retained in Redcap.  This will 
be shared amongst Study Personnel via online password protected access.  Included with this 
submission are the “Column Headings” for the five data collection spreadsheets that will be 
used in this study, one of which is the “De-Identifier” spreadsheet.  
 
Statistical Analysis​:  
A Statistician, affiliated with the Dept of Statistics at UBC, will be retained to run the 
comparative analysis between the rates of return to hospital between the two groups, as well as 
characterizing the group’s demographics of age and gender.  The Statistician will be blinded to 
all personal identifiers.  
 
INVESTIGATION TEAM:  
The Principle Investigator in this study (DJY) is ultimately responsible for all matter of 
data collection and processing.  All others collecting data will be either members of the Dept of 
Anesthesia at VGH & UBCH, or Medical Students from a Canadian University and trained by 
the Principle Investigator in the process of data collection.  Any Medical Students involved in 
this project will be granted the right to participate in data collection by the Dept of Anesthesia 
prior to commencing.  
 
ETHICAL REQUIREMENTS:  
Version Date: Sept 23, 2019
Page 4 of 5 

The study will be performed in accordance with the principles stated in the Tri-Council 
Policy Statement: Ethical Conduct for Research Involving Humans (TCPS2). 
The Principle Investigator is responsible for informing the ethics committees of any major 
amendments to the protocol as per local requirements. All correspondence with the committee 
will be filed by the Principle Investigator. 
 
CONCLUSION:  
This retrospective cohort quality assurance project seeks to make some preliminary 
assessments of the STAR Program’s rate of return to hospital up to 30 days following primary 
hip arthroplasty.  Specifically, the rates of return to hospital are compared between those 
patients discharged from hospital on the day of their surgery, and those who stayed at least one 
night in hospital before being discharged.  Our objective is to use this comparison as a quality 
assurance measure of safety for discharge same day of patients who meet our clinical criteria to 
do so.  
 
REFERENCES:  
1.
Meneghini R, Gibson W, Halsey D, et al. The American Association of Hip and Knee 
Surgeons, Hip Society, Knee Society, and American Academy of Orthopaedic Surgeons 
Position Statement on Outpatient Joint Replacement. The Journal of Arthroplasty 
2018;33:3599-3601.  
2.
Lovald S, Ong K, Lau E, et al. Patient Selection in Outpatient and Short-Stay Total Knee 
Arthroplasty. Journal of Orthopaedic Advances 2014;23(1):1-8.  
3.
Poitras S, Wood KS, Savard J, et al. Predicting early clinical function after hip or knee 
arthroplasty. Bone & Joint Research 2015;4(9):145-151.  
4.
Ziemba-Davis M, Caccavallo P, Meneghini RM. Outpatient Joint Arthroplasty - Patient 
Selection: Update on the Outpatient Arthroplasty Risk Assessment Score. J Arthroplasty 
2019;34(7S):S40-43.  
5.
Meneghini RM, Ziemba-Davis M, Ishmael MK, et al. Safe Selection of Outpatient Joint 
Arthroplasty Patients with Medical Risk Stratifications: the “Outpatient Arthroplasty Risk 
Assessment Score”. J Arthroplasty 2017;32(8):2325-2331.  
6.
Sher A, Keswani A, Yao DH, et al. Predictors of Same-Day Discharge in Primary Total 
Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complicaitons. J 
Arthroplasty 2017;32(9S):S150-S156.  
7.
Kort NP, Bemelmans YFL, van der Kuy PHM, et al. Patient selection criteria for 
outpatient joint arthroplasty. Knee Surg Sports Traumatol Arthrosc 
2017;25(9):2668-2675.  
Version Date: Sept 23, 2019
Page 5 of 5