Hospital stays for patients recovering from joint replacement surgery have been growing shorter and shorter with some surgeons sending hip replacement patients home on the same day as their surgery. Has the shortened stay had an impact, for good or ill on readmission rates?
Shortened Hospital Stay Reduces Readmissions
1 min read Premium comments
Secondary
According to Susan Rapp, writing for Healio Orthopaedics Today, “the first community-based paper on this subject has found shorter hospital stays result in fewer readmissions to the hospital.” A study by Gregory G. Klingenstein, M.D., presented at the American Academy of Orthopaedic Surgeons annual meeting found that Medicare patients admitted to a community hospital for total knee replacement performed in conjunction with rapid discharge protocols had a reduced risk of 30-day readmission with a hospital stay that lasted 1 day compared to 2 days or more. He said, “Our results support the hypothesis that a 1-day length of stay does not increase the risk of readmission.”
Klingenstein and colleagues used a rapid discharge protocol for 2, 064 Medicare patients who were scheduled for unilateral total knee replacement (TKR). Rapp reported that the length of stay for most of these patients was 2 days and 54% of them went home the day after surgery.
The patients who went home within 1 day of surgery tended to be male, less obese, not diabetic and had fewer comorbidities. Thirty-day all-cause readmission was the main outcome measure that the researchers used in their study.
“We had 45 readmissions within 30 days for an overall rate of 2.1%. Now, for patients who went home the day after surgery, the readmission rate was 1.2%. However, for those discharged on postop day 2 or greater, the rate jumped to 3.4 % and the difference was statistically significant, ” Klingenstein said.
Length of stay turned out to be the only factor that was statistically significant for readmission within 30 days. Klingenstein said that patients who went home the day after surgery, were 53% less likely to be readmitted even after controlling for medical comorbidities.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.