Thirty-day readmission rate and discharge status following total hip arthroplasty using the supercapsular percutaneously-assisted total hip surgical technique

Abstract

Purpose Recent studies have reported nearly 40 % of costs associated with a 30-day episode-of-care for total joint replacements are due to post-discharge activities and 81 % of those are specifically due to unplanned readmissions and discharging patients to post-acute care facilities. The purpose of this study was to determine these two key variables for total hip arthroplasty (THA) patients implanted using a tissuesparing surgical technique and to see how these values compare to those previously reported in the United States. Methods The healthcare databases at three institutions were searched for primary THA patients implanted using the supercapsular percutaneously-assisted total hip (SuperPath) surgical technique between January 2013 and July 2014. Data elements included 30-day all-cause readmission rate, discharge status, transfusion rate, complications, and length of stay (LOS). Results Data were available for 479 THAs. The 30-day allcause readmission rate, transfusion rate, and average LOS was 2.3, 3.3 %, and 1.6 days, respectively. Over 91 % of patients were discharged routinely home, 4.1 % to skilled nursing facilities, 3.8 % to home health care, and 0.6 % to inpatient rehabilitation facilities. Complications included dislocation (0.8 %), periprosthetic fracture (0.8 %), and deep vein thrombosis (0.2 %). There were no infections reported. Conclusions Patients implanted using this tissue-sparing technique experienced reduced 30-day all-cause readmission rates (2.3 % vs. 4.2 %) and more were routinely discharged home (91.5 % vs. 27.3 %) than have been previously reported for patients in the United States. Use of this tissue-sparing technique has the potential to significantly reduce post-discharge costs.

In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement

“…Due to the identical anticoagulation and transfusion protocols, the reduction in transfusions can be at least partly attributed to the tissue-sparing nature of the SuperPath procedure. This finding also agrees with the described recent multicentre study showing a substantial reduction in transfusion rates for this technique when compared to the national average in the United States [4]. Transfusions have been associated with increased complications, such as infections [8,9].…”

“…Several of these differences were attributable to the decreased length of stay observed in the SuperPath group. The average length of stay for the Lateral group (5.1 days) was over twice that of the SuperPath group (2.1 days), so it is not surprising that the costs associated with patient rooms (Lateral +60.4 %) and food services (Lateral +62.8 %) were over double for the [4]. Other cost differences, such as for transfusions, were not directly attributable to reduced length of stay.…”

“…The supercapsular percutaneously-assisted total hip (SuperPath®, MicroPort Orthopedics, Arlington, TN, USA) surgical technique is a tissue-sparing approach that preserves the external rotators and does not require the cutting of any muscles or tendons to access the capsule [3]. Recently published multicentre results for this technique showed substantial reductions in length of stay, 30-day readmission rates, and transfusion rates compared to the national average in the United States [4]. That study also provided examples of postdischarge cost savings associated with the reduction of these key variables.…”

Are Readmissions After THA Preventable?

“…The readmission rate at our institution was slightly lower, although comparable to other high-volume joint replacement centers that have reported 30-day readmission rates between 5% and 6% [16,20,31,32,39,44,50,61]. Although some authors have reported 30-day readmission rates as low as 2%, most of these results are for carefully selected patients with nonconventional approaches [19]. Furthermore, reviews of major databases such as the NSQIP 1 have suggested 30-day readmission rates are between 4% and 6% nationwide [49].…”

Two Year Average Follow Up of Supercapsular Percutaneously Assisted Total Hip Arthroplasty; Zero Dislocations

“…[38][39][40] The tissuesparing nature of this approach may allow for decreased time to ambulation, length of stay, 30-day readmission rates, in-hospital costs, and blood loss. [41][42][43] The purpose of the current study was to evaluate the incidence of dislocation at minimum one year follow up in a large series of patients undergoing primary, elective THA using the SuperPATH approach.…”