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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Outpatient vs. inpatient designation in total hip arthroplasty: can we predict who will require hospitalization?
Patrick Connolly1, Jeremiah Thomas1, Thomas Bieganowski1
1Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
Insights
Nearly 20% of total hip arthroplasty (THA) patients scheduled for outpatient surgery required inpatient conversion. Factors like older age, female sex, higher BMI, and comorbidities predict conversion, impacting hospital designation and insurance claims.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Patient Outcomes
Background:
- The Center for Medicare Services (CMS) removed total hip arthroplasty (THA) from the inpatient only (IPO) list, increasing pressure for outpatient (OP) procedures.
- Understanding factors predicting conversion from OP to inpatient (IP) status is crucial for surgical booking and resource allocation.
Purpose of the Study:
- To compare THA patients booked as OP who converted to IP status versus those who remained OP.
- To identify predictive factors for conversion from OP to IP status in THA patients.
Main Methods:
- Retrospective cohort study of 1,937 primary THA patients between January 1, 2020, and April 26, 2022.
- Patients were categorized based on OP booking and subsequent conversion to IP status.
- Multiple regression and binary logistic regression analyses identified significant perioperative and demographic variables.
Main Results:
- 19.2% (372/1,937) of OP-booked THA patients required IP conversion, showing higher discharge and 90-day readmission rates.
- Predictors for conversion included age ≥65, female sex, Black/African American race, late recovery room arrival, BMI >30 kg/m², and Charlson Comorbidity Index (CCI) ≥4.
- Married patients and those undergoing the first procedure of the day were less likely to be converted.
Conclusions:
- Identifying patients at high risk for OP to IP conversion is essential at surgical booking to prevent insurance claim denials.
- Key predictive factors include BMI, specific demographic characteristics, CCI ≥4, and age ≥65.
Introduction:
Following removal of total hip arthroplasty (THA) from the inpatient only (IPO) list by the Center for Medicare Services (CMS), arthroplasty surgeons face increased pressure to perform procedures on an outpatient (OP) basis. The purposes of the present study were to compare patients booked for THA as OP who required conversion to IP status postoperatively, to patients who were booked as, and remained OP, and to identify factors predictive of conversion from OP to IP status.
Methods:
We retrospectively reviewed all patients who underwent a primary THA at our institution between January 1, 2020 and April 26, 2022. All patients included were originally scheduled for OP surgery and were separated based on conversion to IP status postoperatively. Multiple regression analyses were used to determine the significance of all perioperative variables. Modeling via binary logistic regressions were used to determine factors predictive of status conversion.
Results:
Of 1,937 patients, 372 (19.2%) designated as OP preoperatively required conversion to IP status postoperatively. These patients had significantly higher facility discharge rates (P < 0.001) and 90-day readmission rates (P = 0.024). Patients aged 65 and older (P < 0.001), females (P < 0.001), patients with Black/African American race (P = 0.027), with a recovery room arrival time after 12 pm (P < 0.001), with a BMI > 30 kg/m2 (P = 0.001), and with a Charlson Comorbidity Index (CCI) ≥ 4 (P = 0.013) were Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation more likely to require conversion to IP designation. Marital status and time of procedure were also significant factors, as patients who were married (P < 0.001) and who were the first case of the day (P < 0.001) were less likely to be converted to IP.
Conclusion:
Several factors were identified which could help determine appropriate hospital designation status at the time of surgical booking to ultimately avoid insurance claim denials. These included BMI, certain demographic factors, CCI ≥ 4, and patients 65 or older.
Level Iii Evidence:
Retrospective Cohort Study.
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