The impact of "weekend effect" on the outcomes of total joint arthroplasty in the United States.

PURPOSE

In this study we aimed to identify the impact of the weekend effect on complications in patients undergoing total joint arthroplasty (TJA) including total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States.

METHODS

This study is a retrospective cohort study including patients who underwent total joint arthroplasty (i.e. TKA and THA) from 2010 to 2022 across the United States. Patient records were queried from PearlDiver. The 90-days surgical outcomes were compared between patients who had the surgery on weekends and those who underwent the operation on a weekdays.

RESULTS

The study consisted of 2,208,713 patients who underwent TJA; 1,374,018 and 834,695 with TKA and THA, respectively. Ninety-days' incidences of peri-prosthetic joint infection, implant loosening, pneumonia, sepsis, and readmission were higher after TKA surgeries performed on weekends compared to weekdays (OR (95%CI): 4.20 (3.25, 5.44), 2.62 (1.06, 6.45), 1.65 (1.11, 2.43), 3.65 (2.51, 5.29), and 3.14 (2.74, 3.61), respectively). As for THA surgeries, 90 days' incidence of per-prosthetic joint infection, peri-prosthetic fracture, acute renal failure, respiratory failure, sepsis, systemic complications, and readmission were higher among surgeries performed on weekends (OR (95%CI): 4.61 (3.63, 5.85), 2.00 (1.41, 2.83), 1.60 (1.21, 2.11), 1.73 (1.15, 2.60), 2.61 (1.86, 3.67), 1.21 (1.06, 1.39), and 4.12 (3.61, 4.71), respectively).

CONCLUSIONS

TJAs performed on weekends carry higher risk of post-operative complications and poor surgical outcomes. Also, patients undergoing TJA on weekends have a higher prevalence of pre-existing risk factors and poorer baseline health conditions. Findings from this study suggest that access to adequate physical therapy and a rehabilitation centre staffed with skilled nurses on a seven day basis could mitigate complications in patients undergoing TJA during the weekends. Furthermore, high-risk patients should undergo their procedures when hospitals are most well-prepared.