Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates

Kiskaddon, Eric M.; Lee, Jessica H.; Meeks, Brett D.; Barnhill, Spencer; Froehle, Andrew W.; Krishnamurthy, Anil

doi:10.1016/j.arth.2017.11.059

Cited by 18 publications

(11 citation statements)

References 21 publications

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“…Although the BPCI aims at increasing value specifically for a subset of Medicare beneficiaries, we enhanced care pathways for all patients undergoing TJA even before our BPCI enrollment. These efforts, described in full elsewhere [13] , [15] , [19] , resulted in decreased hospital LOS, decreased PAC facility use, and reductions in 30-day and 90-day readmission or reoperation, consistent with findings from other organizations [7] , [8] , [9] , [10] , [11] , [12] . These are important outcomes to the value equation as they indicate improved—or maintained—patient outcomes and likely decreases in costs.…”

Section: Introductionsupporting

confidence: 78%

“…Studies have reported successful cost-containment thus far from bundling payment for TJA. Specifically, costs have been reduced using strategies such as standardization of surgical implants and processes [7] , reduction of postoperative hospital length of stay (LOS) [7] , [8] , [9] , [10] , [11] , [12] , [13] , and decreased use of postacute care (PAC) services [7] , [9] , [14] , [15] in skilled nursing and inpatient rehabilitation facilities. Importantly, it has also been shown that there is no change in unplanned readmission, emergency department use, or mortality in the presence of bundled payment for TJA [9] .…”

Section: Introductionmentioning

confidence: 99%

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Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

et al. 2019

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Background Bundled payment models for lower extremity total joint arthroplasty (TJA) aim to improve value by decreasing costs via efficient care pathways. It is unclear how such models affect patient-centered outcomes such as functional recovery. We aimed to determine whether participation in bundled payment for TJA negatively affects patients’ functional recovery. Methods All patients, regardless of payer, undergoing elective TJA between July 2014 and December 2016 were identified retrospectively and categorized into prebundle (n = 680) and postbundle (n = 1216) cohorts. Mixed-effects linear regression and Wald postests were used to test for differences in patients’ functional recovery during the hospital period and over 12 months after TJA between cohorts. We also used multivariate regression to test for differences in hospital length of stay (LOS) and postacute care (PAC) facility use between cohorts. Results Compared with the prebundle cohort, patients in the postbundle cohort demonstrated a small and nonmeaningful difference in the trajectory of functional recovery in the hospital [χ 2 (3) = 31.3, P < .01] and no difference in the 12 months after TJA [χ 2 (3) = 3.9, P = .28]. They had a 0.4-day shorter hospital LOS (95% confidence interval: −0.5, −0.3) and decreased odds for PAC facility use (adjusted odds ratio = 0.3; 95% confidence interval: 0.2, 0.4). Conclusions Participation in bundled payment for TJA was not associated with significant changes in patients’ functional recovery, an important patient-centered outcome. For the postbundle cohort, hospital LOS and PAC facility use were decreased, consistent with previous studies describing cost-saving strategies in bundled payment. These findings support the need for an ongoing study of the long-term sustainability of these value-based payment models.

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Section: Introductionsupporting

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

et al. 2019

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“…Several studies have reported less readmissions and lower complication rates with discharge home following such procedures. [2][3][4]6,8,10,13 Multiple studies have reported on the factors that can affect a patient's discharge disposition. In a study examining a model to predict home discharge, Gholson et al found that increased age, nonelective procedure for hip fracture, dependent living status, living location other than home before surgery, and elevated ASA class were all predictors of nonhome discharge.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Emergency Department Visits Are Predictive of 90-Day Postoperative Emergency Department Visits and Discharge Disposition in Total Knee Arthroplasty Patients

et al. 2020

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The increasing number of patients undergoing total knee arthroplasty (TKA) has resulted in efforts to better understand patient utilization of healthcare services in the 90-day postoperative period. The primary purpose of this study was to examine whether emergency department (ED) visits in the year prior to elective TKA were predictive of postoperative ED visits in the 90-day global period following surgery. A retrospective chart review was performed for all patients undergoing TKA from June 1, 2011 to December 31, 2015 at a Veterans Affairs hospital. Total number of ED visits in the year prior to surgery and 90 days following surgery were tabulated. Binary and ordinal logistic regression analyses were utilized to determine if preoperative ED visits were predictive of postoperative ED visits. The significance level was set to α = 0.05. Overall, 611 eligible TKA procedures were performed. The logistic regression model for postoperative ED visits was significant (p < 0.001), with the number of preoperative ED visits (1 vs. 0: p < 0.001; 2 vs. 1: p = 0.012) and presence of diabetes (p = 0.007) both predicting the likelihood of a postoperative ED visit. Healthcare changes that are redefining the concept of quality of care to include the postoperative care episode, coupled with an increasingly aging population in need of TKA, will continue to challenge orthopaedic surgeons to provide safe, competent, and cost-effective care to patients. The results of this study demonstrate that a patient's propensity to visit the ED prior to TKA is predictive of a tendency to do so postoperatively and is of use to surgeons when evaluating and counselling patients who will be undergoing a TKA.

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“…However, we would refer them to the results section of the article, in which we discuss in detail the sensitivity analysis that was performed to elicit whether anesthesia type was a confounding factor. To summarize, we found that there was no effect of anesthesia type on discharge disposition, 90-day return to the operating room, 30-day readmissions, and emergency department visits (P ¼ .973, .651, .174, and .170, respectively) [1].…”

mentioning

confidence: 74%

Response to “Letter to the Editor on ‘Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates’”

Kiskaddon

Lee

Meeks

et al. 2018

The Journal of Arthroplasty

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Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates

Cited by 18 publications

References 21 publications

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation

Preoperative Emergency Department Visits Are Predictive of 90-Day Postoperative Emergency Department Visits and Discharge Disposition in Total Knee Arthroplasty Patients

Response to “Letter to the Editor on ‘Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates’”

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