Purpose <p>Studies demonstrate similar long-term Total Knee Arthroplasty (TKA) outcomes in patients with significant versus minimal preoperative coronal plane deformity. Limited short-term outcomes data, which determine costs of care, exist.</p> Methods <p>We retrospectively explored the impact of preoperative coronal plane deformity on operative time, length of stay (LOS), and discharge to skilled nursing facility (SNF) in TKA. A total of 3,964 patients undergoing unilateral primary TKA at our institution from 2014 to 2019 were included (1,158 &gt; 10˚ deformity: mean age 67.2 years, 47% male; 2,806 &lt; 10˚ deformity: mean age 67 years, 37.4% male). The degree of coronal plane deformity (mechanical axis deviation on preoperative radiographs) was recorded. Patients with no knee radiographs <i>≤</i> 3 years preoperatively were excluded. Statistical analysis included Chi-Square tests, Student’s t-tests, Mann-Whitney U tests, and uni- and multivariable linear and logistic regression analyses.</p> Results <p>The &gt; 10˚ deformity cohort had a longer time from procedure start to finish (113.56 vs. 110.68&#xa0;min; <i>p</i> = 0.020), greater deviation from surgeon mean operative time (+ 6.19 vs. + 0.69&#xa0;min; <i>p</i> &lt; 0.001), and higher proportion of cases requiring &gt; 15 (26.8% vs. 22%;<i>p</i> = 0.001) and &gt; 30 (12.3% vs. 7.8%;<i>p</i> &lt; 0.001) additional minutes over their scheduled times. LOS was similar between cohorts (median 2 days, IQR 1–3). The deformity cohort more likely discharged to SNF (19.9% vs. 15.8%;<i>p</i> = 0.002). For every 1˚ increase in coronal plane deformity, operative time increased by 0.566&#xa0;min (<i>p</i> = 0.000). The odds of SNF discharge increased with increasing coronal plane deformity (OR 1.029 [1.009,1.050]; <i>p</i> = 0.004).</p> Conclusion <p>Greater preoperative coronal deformity is associated with increased operative time and odds of discharge to SNF in TKA.</p>