Tags

Type your tag names separated by a space and hit enter

Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?
J Arthroplasty. 2016 12; 31(12):2714-2725.JA

Abstract

BACKGROUND

Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1.

METHODS

Patients undergoing joint arthroplasty between 2011 and 2013 were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Demographics, comorbidities, and 30-day complication and readmission were determined based on discharge date. Propensity-matched comparisons were performed between patients discharged POD 0 vs POD 1. We used multivariate logistic regression to determine independent risk factors for 30-day complication and readmission.

RESULTS

There was no difference in complication or readmission after TKA or UKA between POD 0 or POD 1 discharge. In the propensity-matched cohort in THA, however, there was an increased rate of any complication in the POD 0 compared with the POD 1 discharge cohort. Risk factors for complication and readmission among THA, TKA, and UKA include age >80 years and smoking, and discharge after day 3.

CONCLUSION

Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA.

Authors+Show Affiliations

Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27600301

Citation

Otero, Jesse E., et al. "Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?" The Journal of Arthroplasty, vol. 31, no. 12, 2016, pp. 2714-2725.
Otero JE, Gholson JJ, Pugely AJ, et al. Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates? J Arthroplasty. 2016;31(12):2714-2725.
Otero, J. E., Gholson, J. J., Pugely, A. J., Gao, Y., Bedard, N. A., & Callaghan, J. J. (2016). Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates? The Journal of Arthroplasty, 31(12), 2714-2725. https://doi.org/10.1016/j.arth.2016.07.026
Otero JE, et al. Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates. J Arthroplasty. 2016;31(12):2714-2725. PubMed PMID: 27600301.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates? AU - Otero,Jesse E, AU - Gholson,J Joseph, AU - Pugely,Andrew J, AU - Gao,Yubo, AU - Bedard,Nicholas A, AU - Callaghan,John J, Y1 - 2016/08/09/ PY - 2016/03/06/received PY - 2016/07/28/revised PY - 2016/07/29/accepted PY - 2016/9/8/pubmed PY - 2017/9/22/medline PY - 2016/9/8/entrez KW - comorbidity KW - complications KW - length of stay KW - outpatient joint arthroplasty KW - readmission SP - 2714 EP - 2725 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 31 IS - 12 N2 - BACKGROUND: Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1. METHODS: Patients undergoing joint arthroplasty between 2011 and 2013 were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Demographics, comorbidities, and 30-day complication and readmission were determined based on discharge date. Propensity-matched comparisons were performed between patients discharged POD 0 vs POD 1. We used multivariate logistic regression to determine independent risk factors for 30-day complication and readmission. RESULTS: There was no difference in complication or readmission after TKA or UKA between POD 0 or POD 1 discharge. In the propensity-matched cohort in THA, however, there was an increased rate of any complication in the POD 0 compared with the POD 1 discharge cohort. Risk factors for complication and readmission among THA, TKA, and UKA include age >80 years and smoking, and discharge after day 3. CONCLUSION: Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/27600301/Length_of_Hospitalization_After_Joint_Arthroplasty:_Does_Early_Discharge_Affect_Complications_and_Readmission_Rates L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(16)30448-X DB - PRIME DP - Unbound Medicine ER -