Abstract
Introduction
There have been significant advancements in postoperative care following total hip arthroplasty (THA) over the past decade and it is essential to quantify the impact of efforts made to better optimize patients and improve postoperative care. The purpose of this study was to assess trends in discharge destination, length of stay (LOS), and readmissions following primary THA.
Methods
Patients undergoing primary THA during 2011–2017 were identified in the American College of Surgeons National Quality Improvement Program using CPT code 27130. Non-elective surgery and simultaneous bilateral THA procedures were excluded. Patients were classified as having discharged home or to not home locations. Trends in discharge destination, LOS, 30-day readmission, 30-day reoperation, and American Society of Anesthesiologists (ASA) classification were assessed using the Cochran-Armitage test.
Results
Of the 155,638 primary THA patients analyzed, 81% discharged home and 19% did not discharge home. From 2011–2017 there was a 21% increase in percentage of patients discharging home (72% in 2011, 87% in 2017, p<0.001) despite a significantly increasing number of patients with ASA score ≥ 3 (34% to 40%, p<0.001, Figure 1). Over this time period, hospital LOS decreased from 3.1 to 2.0 days for those discharging home (p<0.001) and from 3.8 to 3.6 days those not discharging home (p=0.003). There were no significant changes in 30-day reoperation rates for patients discharging home and readmission rates significantly decreased over time (3.2% in 2011 to 2.6% in 2017, p=0.02).
Conclusion
From 2011–2017, patients undergoing THA were more likely to discharge home, had shorter hospital LOS and significantly decreased readmission rates. These trends persisted despite an increasingly comorbid patient population. It is likely these trends have resulted in significant cost savings, for both payers and hospitals. The efforts necessary to create and maintain such improvements should be considered when changes to reimbursement are being evaluated.
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