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Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications.
J Arthroplasty. 2017 09; 32(9S):S150-S156.e1.JA

Abstract

BACKGROUND

Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population.

METHODS

Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database.

RESULTS

In total, 7474 primary TJAs among 120,847 TJA patients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population.

CONCLUSION

Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas, Integrated Practice Unit for Musculoskeletal Care, Austin, Texas.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28089186

Citation

Sher, Alex, et al. "Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications." The Journal of Arthroplasty, vol. 32, no. 9S, 2017, pp. S150-S156.e1.
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 Complications. J Arthroplasty. 2017;32(9S):S150-S156.e1.
Sher, A., Keswani, A., Yao, D. H., Anderson, M., Koenig, K., & Moucha, C. S. (2017). Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications. The Journal of Arthroplasty, 32(9S), S150-e1. https://doi.org/10.1016/j.arth.2016.12.017
Sher A, et al. Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications. J Arthroplasty. 2017;32(9S):S150-S156.e1. PubMed PMID: 28089186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of Same-Day Discharge in Primary Total Joint Arthroplasty Patients and Risk Factors for Post-Discharge Complications. AU - Sher,Alex, AU - Keswani,Aakash, AU - Yao,Dong-Han, AU - Anderson,Michael, AU - Koenig,Karl, AU - Moucha,Calin S, Y1 - 2016/12/22/ PY - 2016/08/04/received PY - 2016/11/24/revised PY - 2016/12/13/accepted PY - 2017/1/17/pubmed PY - 2018/4/18/medline PY - 2017/1/17/entrez KW - expedited discharge KW - hip arthroplasty KW - knee arthroplasty KW - outpatient surgery KW - patient selection criteria KW - same-day discharge SP - S150 EP - S156.e1 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9S N2 - BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population. METHODS: Bivariate and multivariate analyses were performed using perioperative variables from the 2011 to 2014 National Surgical Quality Improvement Program database. RESULTS: In total, 7474 primary TJAs among 120,847 TJA patients were discharged within 24 h post-surgery. These patients were more likely to be younger (<50 years), male sex, American Society of Anesthesiologists class 1 or 2, and less likely to be obese or taking steroids (P < .05 for all). They were also less likely to have co-morbidities. Rates of severe adverse event (SAE) or unplanned readmission post-discharge were 1.3% and 1.9%, respectively. Multivariate analysis identified age >80 (odds ratio [OR] 4.16, P = .001), smoking (OR 1.61, P = .03), bleeding-causing disorders (OR 2.56, P = .01), American Society of Anesthesiologists class 3 or 4 (OR 1.42, P < .05), and SAE pre-discharge (OR 13.13, P < .0001) as independent predictors for adverse events or readmission in this population. CONCLUSION: Patient characteristics, co-morbidities, and SAEs pre-discharge can be used to assess potential for discharge within 24 h. The results of our analysis may be used to develop risk stratification tools for identification of patients that are truly appropriate for same-day discharge TJA. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28089186/Predictors_of_Same_Day_Discharge_in_Primary_Total_Joint_Arthroplasty_Patients_and_Risk_Factors_for_Post_Discharge_Complications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(16)30902-0 DB - PRIME DP - Unbound Medicine ER -