Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty

Ponnusamy, Karthikeyan; Naseer, Zan A.; Dafrawy, Mostafa H. El; Okafor, Louis; Alexander, Clayton P.; Sterling, Robert S.; Khanuja, Harpal S.; Skolasky, Richard L.

doi:10.2106/jbjs.16.00166

Cited by 73 publications

(42 citation statements)

References 23 publications

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“…We found that 90.2% of patients undergoing the intensive PT protocol were discharged home, as compared to only 75.5% of patients who participated in non-intensive PT protocol (p < 0.03). Although these values are substantially higher than those reported in other studies, they demonstrate similar outcomes--rigorous postoperative PT enables patients to be discharged home sooner [19] . Additionally, Brennan et al [20] .…”

Section: Patient Demographicscontrasting

confidence: 48%

The Role of Physical Therapy in Decreasing Length of Stay Following Total Knee Arthroplasty in a Public Hospital Setting

Moses

Novikov

Anoushiravani

et al. 2018

International Journal of Orthopaedics

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Section: Patient Demographicscontrasting

confidence: 48%

The Role of Physical Therapy in Decreasing Length of Stay Following Total Knee Arthroplasty in a Public Hospital Setting

Moses

Novikov

Anoushiravani

et al. 2018

International Journal of Orthopaedics

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“…Previous prospective studies have also been underpowered to detect differences in complication rates between outpatient and inpatient care groups. Due to the already low rates of serious adverse events after THA, reported from 3.8% up to 8.6% in the literature, [20,35,36] sample sizes must be sufficiently large to include a sufficient number of events to support clinical conclusions. Our protocol will be the first adequately powered prospective study to evaluate the safety of outpatient THA.…”

Section: Discussionmentioning

confidence: 99%

A protocol for a randomized controlled trial investigating the safety and cost-effectiveness of outpatient total hip arthroplasty

Zomar

Marsh

Lanting

et al. 2020

BMC Musculoskelet Disord

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Background A significant proportion of the overall cost of total hip arthroplasty (THA) results from the inpatient hospital stay following the procedure. Considering the substantial and increasing number of these procedures performed annually, shifting to an outpatient model of care where the patient is discharged home the same day as their surgery represents a potential for significant cost savings. The potential significant impact of an outpatient care model on constrained healthcare budgets and lack of high-quality evidence regarding its effectiveness warrants a rigorous comparative trial. The purpose of this prospective, randomized controlled trial is to evaluate outpatient care pathways for THA. Specifically, our objectives are to compare the rate of serious adverse events and estimate the cost-effectiveness of outpatient compared to standard inpatient THA. Methods We will include patients undergoing primary THA whom have an American Society of Anaesthetists status equal to or less than three, live within a 60-min driving distance of the institution and have an adult to accompany them home postoperatively and stay with them overnight. Consenting patients will be randomized to be discharged on the same day as surgery, as outpatients, or as inpatients according to standard of care (minimum of one night in hospital) using a modified Zelen consent model. The primary outcome measure is the incidence of serious adverse events at 30 days postoperative. Participants and their caregivers will complete secondary outcomes measures at each follow-up visit including patient-reported outcome measures and self-reported cost questionnaires. Discussion This protocol is the first randomized trial to use blinding to evaluate outpatient THA compared to standard overnight stay and first to prospectively perform a full economic evaluation. It is also the first adequately powered trial to prospectively assess the safety of outpatient THA. Successful completion of this study could have the potential to provide clinical evidence for the role of outpatient THA in current practice. Trial registration This study was retrospectively registered on ClinicalTrials.gov (NCT03026764) on March 9th, 2016.

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“…6,12 Discharging patients home instead of PAC inpatient facilities can save up to US$14,000 per EOC. 13 In fact, it has been demonstrated that extending a patient's hospital stay by an additional 5.2 days in an effort to discharge the patient directly home resulted in reduced overall costs and superior outcomes than THA recipients who were discharged to a PAC facility. 14 Despite these advantages, it is important to properly assess which patients will need postacute inpatient care.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Patient-Reported Outcomes May Help Predict Discharge Disposition after Total Hip Arthroplasty

et al. 2019

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Patient-reported outcome (PRO) instruments are measures that allow for a standardized assessment of a patient's functional status, symptoms, and quality of life (QoL) through self-reported questionnaires. The purpose of this study was to assess the relationship between PRO scores, which measure patients' preoperative pain and functional status, and discharge disposition in the total hip arthroplasty (THA) population. The authors conducted a retrospective review of patients with a primary diagnosis of osteoarthritis who underwent THA at a single, urban, tertiary care center between September 2013 and August 2016. Patient demographics and preoperative PRO scores (Hip Disability and Osteoarthritis Outcome Score [HOOS] and EuroQol 5-Dimension [EQ-5D] questionnaire) were collected, and discharge disposition was categorized into the following two cohorts: THA recipients discharged to home and those discharged to a postacute care facility. When comparing PRO scores between the two groups, patients discharged home were found to have significantly higher average preoperative global EQ-5D, EQ-5D-QoL, HOOS activities of daily living (ADL), HOOS pain, HOOS sports, and HOOS symptoms scores. Patients discharged home trended toward higher HOOS QoL scores (28.1 vs. 22.6%), but this did not achieve significance (p < 0.08). The authors found a significant relationship between patients' baseline PRO scores and discharge disposition following THA. Patients discharged home had significantly higher preoperative PRO scores as measured by EQ-5D and HOOS. This demonstrates that patients with lower baseline PRO scores, indicating lower baseline function, may require additional care following surgery. These scores provide surgeons with an objective parameter that can assist in the planning and coordination of postoperative care. This study was a level III retrospective cohort.

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Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 73 publications

References 23 publications

The Role of Physical Therapy in Decreasing Length of Stay Following Total Knee Arthroplasty in a Public Hospital Setting

The Role of Physical Therapy in Decreasing Length of Stay Following Total Knee Arthroplasty in a Public Hospital Setting

A protocol for a randomized controlled trial investigating the safety and cost-effectiveness of outpatient total hip arthroplasty

Preoperative Patient-Reported Outcomes May Help Predict Discharge Disposition after Total Hip Arthroplasty

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