Presentation Abstract

Session: 361-375-Adult Reconstruction Knee IV
Date/Time: Thursday, Mar 13, 2014, 8:48 AM - 8:54 AM
Location Theater A
Presentation Number: Paper 367
Title: Implications of Outpatient vs. Inpatient Total Joint Arthroplasty on Hospital Readmission Rates
Classification: +Complications (Knee)
Keywords: Outcomes; Total Knee Arthroplasty Complications
Author(s): David N. Vegari, MD, Philadelphia, Pennsylvania
Jeffrey G. Mokris, MD, Charlotte, North Carolina
Susan M. Odum, PhD, Charlotte, North Carolina
Bryan D. Springer, MD, Charlotte, North Carolina
Abstract: INTRODUCTION: Recent advances in total joint arthroplasty (TJA) have focused on pain management, accelerated rehabilitation and ultimately earlier hospital discharge. Many surgeons are now performing TJA as a same-day procedure, i.e. patient discharge less than 24 hours after surgery. Under the Patient Care and Affordability Act, Medicare is now focusing on 30-day readmission rates after TJA and penalizing hospitals financially for such readmissions. The purpose of this study is to compare readmission rates in patients undergoing outpatient versus inpatient TJA and identify if this variable influenced hospital readmissions rates during the 30-day post-operative period.
METHODS: Between September 2010 and May 2011, 232 patients underwent an outpatient TJA by one surgeon. Criteria for outpatient surgery consisted of Body Mass Index<40 kg/m2, no active cardiopulmonary issues, no sleep apnea, no history of deep venous thrombosis or pulmonary embolus, live less than one hour from hospital and good family support). During this same time period and at the same hospital, 148 patients were matched using the same outpatient criteria but underwent inpatient (minimum two-day hospital stay) TJA per surgeon preference. A total of 235 patients (137 outpatients and 98 inpatient s) completed a telephone survey consisting of 14 questions related to hospital readmissions, unplanned care and patient satisfaction.
RESULTS: With the numbers available, there were no statistical differences in readmission rates between inpatient and outpatient TJA. Six of 98 (6.1%) inpatients were readmitted to the hospital within the first 30 days as compared to 14 of 137 (10%) outpatients (p=0.27). When combining emergency room visits with hospital readmissions, 7% (seven of 98) of inpatients and 12% (17 of 137) of outpatients (p=0.19) required unplanned medical care following hospital discharge. No statistical differences were found between the two groups when stratified by joint, i.e. hips versus knees or for readmission during the first four post-operative days. The length of stay had no effect on any patient satisfaction measurements.
DISCUSSION AND CONCLUSION: Thirty-day hospital readmission rates are now a critical component of quality improvement initiatives. Public reporting of this measure is already occurring and financial penalties to hospitals will begin in 2015. As outpatient TJA gains in popularity we sought to determine if it affected readmission rates or patient satisfaction when compared to a matched inpatient cohort who met outpatient criteria. We found no statistical difference for readmission, emergency room visits or patient satisfaction in either cohort. In properly selected patients, the outcomes of outpatient TJA are comparable to inpatient arthroplasty without increasing readmission rates and financially penalizing hospitals.

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