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Length of Stay Increases 90-day Readmission Rates in Patients Undergoing Primary Total Joint Arthroplasty
Jorge Benito1, Justin Stafford, Hyrum Judd
1From the Larkin Medical Center, Department of Orthopedic Surgery, Miami, FL (Dr. Benito, Dr. Stafford, Dr. Judd, and Dr. Corces), and the Holy Cross Hospital, Orthopedic Research Institute, Ft. Lauderdale, FL (Dr. Ng, and Dr. Roche).
Insights
A length of stay (LOS) longer than 1 day after total knee arthroplasty (TKA) or total hip arthroplasty (THA) significantly increases 90-day readmission odds. Early discharge planning is crucial for preventing readmissions.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Patient Outcomes
Background:
- Investigating the impact of postoperative length of stay (LOS) on 90-day readmissions after primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).
- Comparing a 1-day LOS with a 2- to 4-day LOS in TKA and THA patients.
Purpose of the Study:
- To determine the association between extended postoperative LOS and 90-day readmission rates following TKA and THA.
- To identify if a shorter LOS is associated with lower readmission rates.
Main Methods:
- Utilized PearlDiver database to analyze 648,758 TKA and 346,732 THA patients from 2005-2014.
- Matched control (LOS=1 day) and study (LOS=2-4 days) groups based on age, sex, and Elixhauser Comorbidity Index.
- Employed logistic regression and odds ratio analysis to assess 90-day readmission rates.
Main Results:
- TKA patients with LOS of 2, 3, or 4 days showed significantly higher odds of 90-day readmission (ORs ranging from 2.80 to 2.89) compared to a 1-day LOS.
- THA patients with LOS of 2, 3, or 4 days also demonstrated significantly increased odds of 90-day readmission (ORs ranging from 2.91 to 2.93) versus a 1-day LOS.
- All comparisons indicated statistical significance (P < 0.05).
Conclusions:
- A postoperative length of stay exceeding 1 day is associated with significantly greater odds of 90-day readmission after TKA and THA.
- Optimizing early discharge, considering patient-specific risk factors, is essential for reducing readmission rates post-arthroplasty.
Background:
Postoperative length of stay (LOS) of 1 day compared with that of 2 to 4 days after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) and 90-day readmissions.
Methods:
PearlDiver identified TKA (n = 648,758) and THA patients (n = 346,732) between 2005 and 2014. Groups consisted of control (LOS = 1 day) and study (LOS = 2 to 4 days) groups. Study and control groups were matched to age, sex, and Elixhauser Comorbidity Index. Logistic regression analysis and odds ratio analyzed 90-day readmission rates. P < 0.05 was statistically significant.
Results:
TKA patients' LOS of 2 days (odds ratio [OR], 2.89; 95% confidence interval [CI], 2.77 to 3.00), LOS of 3 days (OR, 2.80; 95% CI, 2.69 to 2.91), and LOS of 4 days (OR, 2.83; 95% CI, 2.72 to 2.95) had greater 90-day readmission compared with LOS of 1 day (P < 0.05). THA patients with an LOS of 2 days (OR, 2.93; 95% CI, 2.77 to 3.10), an LOS of 3 days (OR, 2.91; 95% CI, 2.75 to 3.07), or an LOS of 4 days (OR, 2.91; 95% CI, 2.73 to 3.05) had greater 90-day readmission compared with an LOS of 1 day (P < 0.05).
Conclusion:
LOS >1 day has greater odds of 90-day readmission after an index procedure. Efficient progression to early discharge regarding patient-specific risk factors plays a large role in preventing readmission.
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