Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?

• Published in: The Journal of arthroplasty 2016-12, Vol.31 (12), p.2714-2725
• Main Authors: Otero, Jesse E., MD, PhD, Gholson, J. Joseph, MD, Pugely, Andrew J., MD, Gao, Yubo, PhD, Bedard, Nicholas A., MD, Callaghan, John J., MD
• Format: Article
• Language: English
• Subjects: Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Cohort Studies; Comorbidity; complications; Female; Humans; Length of Stay; Logistic Models; Male; Middle Aged; Orthopedics; outpatient joint arthroplasty; Patient Discharge; Patient Readmission - statistics & numerical data; Patient Selection; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Period; Quality Improvement; readmission; Risk Factors; United States - epidemiology
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.07.026

Abstract Background Length of hospital stay is a quality metric in joint arthroplasty. Rapid recovery protocols have safely reduced the average length of hospitalization, but it is unclear whether there is a difference in complication and readmission rates between patients discharged the day of surgery or on postoperative day 1 (POD 1). We calculated 30-day complication and readmission after total knee arthroplasty (TKA), total hip arthroplasty (THA), and unicompartmental knee arthroplasty (UKA) based on day of discharge. We then analyzed the rapid recovery group by comparing those discharged the day of surgery and those discharged on POD 1. Methods Patients undergoing joint arthroplasty between 2011 and 2013 were selected from the American College of Surgeons (ACS) National Surgical Quality Improvement Program. Demographics, comorbidities, and 30-day complication and readmission were determined based on discharge date. Propensity-matched comparisons were performed between patients discharged POD 0 vs POD 1. We used multivariate logistic regression to determine independent risk factors for 30-day complication and readmission. Results There was no difference in complication or readmission after TKA or UKA between POD 0 or POD 1 discharge. In the propensity-matched cohort in THA, however, there was an increased rate of any complication in the POD 0 compared with the POD 1 discharge cohort. Risk factors for complication and readmission among THA, TKA, and UKA include age >80 years and smoking, and discharge after day 3. Conclusion Increased length of stay is associated with increased complication and readmission after joint arthroplasty for patients with a hospital stay of 3 or more days. However, in THA, there was an increased complication rate in patients discharged POD 0 as compared to POD 1. Efforts to improve patient selection are expected to reduce short-term complications after outpatient joint arthroplasty. Further research is needed to determine which patients can be discharged POD 0 without increased complication after THA.