Increasing Patient Age and General Anesthesia are Risk Factors for Readmission after Same-Day Discharge in Total Hip
Mohamed-Ali Sareini1, Kevin X Farley1, Rami S Beydoun1
1Department of Orthopedic Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, MI, USA.
Insights
Same-day discharge total hip arthroplasty (THA) is increasingly common. A study of 22,575 patients found a low 1.6% readmission rate, indicating safety, with age and general anesthesia as key risk factors.
Area of Science:
- Orthopaedic Surgery
- Health Services Research
Background:
- Rising cost containment efforts and policy changes have accelerated same-day discharge total hip arthroplasty (THA).
- The COVID-19 pandemic further influenced the trend of same-day discharge THA.
Purpose of the Study:
- To identify risk factors associated with 30-day readmission after same-day discharge THA.
- To evaluate the safety and trends of same-day discharge THA.
Main Methods:
- Analysis of the National Surgical Quality Improvement Project database (2012-2021).
- Inclusion of elective THA patients discharged on the same day of surgery.
- Statistical analysis including chi-square and multivariate logistic regression to identify readmission risk factors.
Main Results:
- The proportion of same-day discharge THA increased from <1% to 26% between 2012 and 2021.
- A total of 22,575 patients were analyzed, with a 1.6% 30-day readmission rate.
- Increased patient age (over 85) and higher modified frailty index scores were significant risk factors for readmission. Neuraxial anesthesia was associated with lower readmission rates compared to general anesthesia.
Conclusions:
- Same-day discharge THA is a safe and increasingly utilized procedure with a low overall readmission rate.
- Patient age and anesthetic type are significant predictors of readmission following same-day THA.
- Further research may focus on optimizing patient selection and anesthetic protocols to minimize readmission risks.
Background:
As cost containment efforts in orthopaedic surgery increase, there has been a rise in same-day discharge total hip arthroplasty (THA). This has been further accelerated by the COVID-19 pandemic and the removal of THA from the Medicare inpatient-only list. This study sought to evaluate risk factors for readmission following same-day discharge THA.
Methods:
From 2012-2021, the National Surgical Quality Improvement Project database was used to identify all patients undergoing elective THA discharged the day of surgery. Demographic, comorbid, and operative variables were collected. Readmission within 30 days of surgery was identified. Chi-square analysis and multivariate logistic regression was used to identify risk factors for readmission.
Results:
In total, 22,575 patients were identified undergoing same-day discharge THA. The proportion of same-day discharges increased from <1% in 2012 to 26% in 2021. 370 patients (1.6%) were readmitted within 30 days of surgery. Readmission rates were 1.5% in patients age 55-64 and 4.7% in those over 85 years (P < .001). There were lower readmission rates in those receiving neuraxial anesthesia compared to general anesthesia (1.5% vs 1.9%; P = .024). Patients with a modified frailty index score of 1 (2.0%) or 2+ (2.9%) also had increased risk of readmissions (P > .001).
Conclusions:
Same-day discharge THA has increased rapidly in recent years. With a readmission rate of only 1.6% within 30 days of surgery, it appears to be a safe option for patients undergoing THA. Increasing patient age was the most significant risk factor for readmission following same-day surgery followed by the use of general anesthesia.
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