Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population

Feder, Oren I.; Lygrisse, Katherine A.; Hutzler, Lorraine; Schwarzkopf, Ran; Bosco, Joseph; Davidovitch, Roy I.

doi:10.1016/j.arth.2019.09.040

Cited by 22 publications

(17 citation statements)

References 24 publications

(18 reference statements)

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“…Similarly, in a large database query of 1220 outpatient primary TJAs between 2011 and 2014, Courtney et al [ 39 ] reported no increased risk of readmissions or complications, a finding that has been reproduced in a number of other studies [ [40] , [41] , [42] ]. Moreover, Feder et al [ 43 ] evaluated the safety of 850 same day discharge TJA patients at a single institution and noted a 90-day readmission rate of 0.94% and a 90-day ED rate of 1.18%. The higher rates noted in our study can be explained by the findings of Schairer et al, who showed that patients undergoing revision TKA [ 44 ] and THA [ 45 ] were more likely to have an unplanned readmission than patients undergoing primary TJA.…”

Section: Discussionmentioning

confidence: 99%

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Buller

Hubbard

Ziemba-Davis

et al. 2021

The Journal of Arthroplasty

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Background Advances in perioperative care have enabled early discharge and outpatient primary total joint arthroplasty (TJA). However, the safety of early discharge after revision TJA (rTJA) remains unknown and the COVID-19 pandemic will force decreased hospitalization. This study compared 90-day outcomes in patients undergoing aseptic rTJA discharged the same or next day (early) to those discharged 2 or 3 days postoperatively (later). Methods In total, 530 aseptic rTJAs performed at a single tertiary care referral center (December 5, 2011 to December 30, 2019) were identified. Early and later discharge patients were matched as closely as possible on procedure type, sex, American Society of Anesthesiologists physical status classification, age, and body mass index. All patients were optimized using modern perioperative protocols. The rate of 90-day emergency department (ED) visits and hospital admissions was compared between groups. Results In total, 183 early discharge rTJAs (54 hips, 129 knees) in 178 patients were matched to 183 later discharge rTJAs (71 hips, 112 knees) in 165 patients. Sixty-two percent of the sample was female, with an overall average age and body mass index of 63 ± 9.9 (range: 18-92) years and 32 ± 6.9 (range: 18-58) kg/m 2 . There was no statistical difference in 90-day ED visit rates between early (6/178, 3.4%) and later (11/165, 6.7%) discharge patients ( P = .214). Ninety-day hospital admission rates for early (7/178, 3.9%) and later (4/165, 2.4%) discharges did not differ ( P = .545). Conclusion Using modern perioperative protocols with appropriate patient selection, early discharge following aseptic rTJA does not increase 90-day readmissions or ED visits. As hospital inpatient capacity remains limited due to COVID-19, select rTJA patients may safely discharge home the same or next day to preserve hospital beds and resources for more critical illness.

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Section: Discussionmentioning

confidence: 99%

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Buller

Hubbard

Ziemba-Davis

et al. 2021

The Journal of Arthroplasty

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“…Given that the rate of same-day TJA is expected to increase in the near future [31,32], additional studies on healthcare quality assessment and improvement are still necessary. First, further studies are required to validate the risk-scoring system, which was designed to be aggressive to prevent missing any severe abnormality or even subsequent complications; moreover, the prediction accuracy of the points-based risk-scoring system warrants further validation.…”

Section: Call For Future Studiesmentioning

confidence: 99%

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

Zhu

Xiao

et al. 2020

The Journal of Arthroplasty

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Background: Recently, the practice of ordering routine postoperative laboratory tests in primary total hip arthroplasty (THA) has been challenged. This study aimed to evaluate the utility of routine postoperative laboratory tests after primary elective THA in an Asian population and identify the risk factors associated with abnormal postoperative laboratory testerelated intervention. Methods: We retrospectively reviewed 395 consecutive patients who underwent primary elective THA at a single tertiary academic center. Patient clinical information and laboratory test results were collected for analysis. Results: A total of 349 (88.4%) patients had abnormal postoperative laboratory test results; most patients had anemia and hypoalbuminemia. Twenty-seven (6.8%) patients received clinical intervention. Of the 307 (77.7%) patients with postoperative anemia, 7 patients received blood transfusion. Factors associated with transfusion were female gender, low body mass index, long operation time, and low preoperative hemoglobin levels. Of the 149 (37.7%) patients with postoperative hypoalbuminemia, 16 received albumin supplementation. Factors associated with albumin supplementation were female gender, long operation time, and low preoperative albumin levels. Although 36 patients had abnormal postoperative creatinine, only 1 patient required specialist consultation. For electrolyte abnormalities, hyponatremia was noted; however, no patient received sodium supplementation. Moreover, 14 patients developed hypokalemia, of which 6 required potassium supplementation; 163 patients had hypocalcemia, of which 2 received calcium supplementation. Conclusion: Routine laboratory tests after primary elective THA are unnecessary for most of the patients in modern clinical practice. However, for those with identified risk factors, postoperative laboratory tests still should be performed.

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“…20,25 The 30-day readmission and reoperation rate following outpatient THA was low (<4%) in our study, similar to complication rates reported in other studies with broader inclusion criteria. 17,19,26,27 In one large investigation by Berend et al, 1472 outpatient THAs performed at a stand-alone ASC were analyzed, and 44% of patients had 1 or more major comorbidity, with an overall complication rate of 2.2%. 2 In our study, the predictors for 30-day reoperation after outpatient THA in Medicare aged patients were COPD and HTN.…”

Section: Discussionmentioning

confidence: 99%

“…While numerous studies have evaluated TKA and THA in the outpatient setting broadly, few studies have focused investigations in Medicare eligible patients strictly in the outpatient setting. [17][18][19] In light of the recent CMS change regarding removal of THA from the inpatient only (IPO) list, we sought to use a national surgical database to answer our primary research questions: 1) What is the frequency of non-home discharge to a facility for Medicare eligible patients ( 65 years of age) undergoing outpatient THA? and 2) What are the predictors for a non-home discharge in this population?…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Discharge to a Non-Home Destination and Reoperation Following Outpatient Total Hip Arthroplasty (THA) in Medicare-Eligible Patients

Gordon

Malik

Khan

2021

Geriatr Orthop Surg Rehabil

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Introduction: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only (IO) list in January 2020. Given this recommendation, we analyzed Medicare-eligible patients undergoing outpatient THA to understand risk factors for nonroutine discharge, reoperations, and readmissions. Materials and Methods: The 2015-2018 American College of Surgeons–National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27130 for Medicare eligible patients (≥ 65 years of age) undergoing outpatient THA. Postoperative discharge destination was categorized into home and non-home. Multivariate logistic regression models were used to evaluate risk factors associated with non-home discharge disposition. Secondarily, we evaluated rates and risk factors associated with 30-day reoperations and readmissions. Results: A total of 1095 THAs were retrieved for final analysis. A total of 108 patients (9.9%) experienced a non-home discharge postoperatively. Patients were discharged to rehab (n = 47; 4.3%), a skilled care facility (n = 47; 4.3%), a facility that was “home” (n = 8; 0.7%), a separate acute care facility (n = 5; 0.5%), or an unskilled facility (n = 1; 0.1%). Independent factors for a non-home discharge were American Society of Anesthesiologists Class >II (odds ratio [OR] 2.74), operative time >80 minutes (OR 2.42), age >70 years (OR 2.20), and female gender (OR 1.67). Eighteen patients (1.6%) required an unplanned reoperation within 30 days. A total of 40 patients (3.7%) required 30-day readmissions, with 35 readmissions related to the original THA procedure. Independent risk factors for 30-day reoperation were COPD (OR 5.85) and HTN (OR 5.24). Independent risk factors for 30-day readmission were HTN (OR 4.35) and Age >70 (OR 2.48). Discussion: The current study identifies significant predictors associated with a non-home discharge, reoperation, and readmission in Medicare-aged patients undergoing outpatient THA. Conclusion: Providers should consider preoperatively risk-stratifying patients to reduce the costs associated with unplanned discharge destination, complication or reoperation.

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Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population

Cited by 22 publications

References 24 publications

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Safety of Same and Next Day Discharge Following Revision Hip and Knee Arthroplasty Using Modern Perioperative Protocols

Are Routine Postoperative Laboratory Tests Necessary After Primary Total Hip Arthroplasty?

Risk Factors for Discharge to a Non-Home Destination and Reoperation Following Outpatient Total Hip Arthroplasty (THA) in Medicare-Eligible Patients

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