New data suggest same-day discharge is safe for joint replacement patients with atrial fibrillation

Editor's Note

According to a study presented at the American Academy of Orthopaedic Surgeons 2025 Annual Meeting, same-day discharge for total joint arthroplasty (TJA) patients with a history of atrial fibrillation (AF) is both feasible and safe, Medscape March 31 reports. This finding challenges the common assumption that patients with AF require overnight observation due to heightened risk of perioperative complications, such as thromboembolic events.

The research team sought to determine if keeping TJA patients with AF overnight offered any tangible benefits, as historically, providers have favored extended observation for these patients, believing they would benefit from additional monitoring. However, with outpatient joint replacement becoming more prevalent, the researchers felt it was critical to examine whether expedited discharge truly increases the risk of postoperative complications.

The study compared two groups of TJA patients treated between January 2019 and June 2023: those with a history of AF admitted as inpatients, and those without AF who were discharged on the same day. Following 1:1 propensity matching, each group contained 761 patients. Results showed no statistically significant difference in emergency department visits within 72 hours (1.71% vs 0.79%; P = .115) or within 7 days (1.97% vs 1.84%; P = .851) between the AF inpatient cohort and the outpatient cohort without AF. Additionally, a preoperative diagnosis of AF did not appear to increase the risk of cardiac events in the first 24 hours after surgery (P = .965).

Nader A. Nassif, MD, chief of joint replacements at the Hoag Orthopedic Institute in Irvine and lead researcher of the study, noted patients with AF do have higher rates of readmission within 30 days (3.42% vs 0.45%; P < .001) compared to those without the condition, per the outlet. He emphasized, however, that these data do not suggest same-day discharge is unsafe, as the elevated readmission rate appears unrelated to the shorter discharge timeline.