Optimal Length of Stay Following Total Joint Arthroplasty to Reduce Readmission Rates |
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| Institution: | 1. Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, NC;2. Department of Orthopaedics, Medical University of South Carolina, Charleston, SC;3. Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH;4. Department of Orthopaedics, Harvard-Beth Israel Deaconess Medical Center, Boston, MA;1. Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan;2. Department of Clinical Biomechanics, School of Medicine, Keio University, Tokyo, Japan;1. Department of Orthopaedic Surgery, Putrajaya Hospital, Putrajaya, Malaysia;2. Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, South Korea;3. Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea;4. Department of Orthopaedic Surgery, Seoul Hospital, Seongnam-si, South Korea;5. Department of Orthopaedic Surgery and Traumatology, Sarawak General Hospital, Kuching, Malaysia;1. Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY;2. Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA;3. Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC;4. Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA |
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| Abstract: | BackgroundLength of stay (LOS) following total joint arthroplasty (TJA) continues to decrease. The effects of this trend on readmission risk and total cost are unclear. We hypothesize that optimal LOS following TJA minimizes index hospitalization, early readmission risk, and total cost.MethodsRetrospective data from the South Carolina Department of Revenue and Fiscal Affairs was reviewed for patients who underwent primary TJA in South Carolina from 2000 to 2015 (n = 172,760). Data for readmissions within 90 days were included. Severity of illness was estimated by Elixhauser score (EH). Index LOS is defined as the surgery and the subsequent hospital stay.ResultsPatients with more significant medical comorbidities (EH ≥ 4) had significantly longer LOS than healthier patients (4.0 vs 3.4 days, P < .001). Independent of EH, readmitted patients had a significantly longer index LOS than those never readmitted (4.3 vs 3.6 days, P < .001). For healthier patients (EH ≤ 3), each additional inpatient day increased readmission risk, while among sicker patients, staying 2 days vs 1 day was protective against readmission risk. Since 2000, the total index cost of TJA has doubled and average cost per inpatient day has tripled, but readmission rates remain essentially unchanged (7.4% to 7.0%).ConclusionIncreased LOS was associated with increased readmission risk. Patients with greater medical comorbidities stay longer to protect against readmission. Optimal LOS after TJA is highly influenced by the patient’s overall health. Despite a 300% increase in TJA daily cost, readmission rate has changed minimally over the last 15 years. |
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| Keywords: | total joint arthroplasty total hip arthroplasty total knee arthroplasty readmission comorbidity cost |
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