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Decreased length of hospital stay, but increased readmissions found after hip replacement

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A recently published study in Journal of the American Medical Association on Medicare beneficiaries undergoing total hip arthroplasty showed that the average length of hospital stay and proportion of patients discharged home decreased between 1991 and 2008, while the rate of hospital readmissions and discharge to skilled care facilities increased.

According to a Journal of the American Medical Association (JAMA) press release, Peter Cram, MD, MBA, and colleagues included data between 1991 and 2008 on 1,453,493 Medicare Part A beneficiaries who underwent primary total hip arthroplasty (THA) and 348,596 beneficiaries who underwent revision THA.

The investigators found that the average hospital length of stay for primary THA decreased from 9.1 days between 1991 to 1992, to 3.7 days in 2007 to 2008. Patients discharged to skilled or intermediate care increased from 17.8% to 34.3% during those time periods. In addition, patients discharged home decreased from 68% to 48.2%. They found similar trends for revision THA.

Three trends were found in the analysis done to determine what other changes might result as length of hospital stays decreased in this population, as noted in the release.

“We found that despite increasing patient complexity, both unadjusted and adjusted mortality for primary total hip arthroplasty showed substantial improvement over time Conversely, our second finding was that for revision total hip arthroplasty, unadjusted mortality appeared to increase modesty but this increase was largely explained by increasing patient complexity. Third and most importantly, marked declines in hospital LOS for both primary and revision total hip arthroplasty seemed to correspond with an increase in the proportion of patients who were discharged to postacute care and an increase in patient readmissions," Cram and colleagues wrote in the study.

After adjusting for patient characteristics, they also found that 90-day mortality decreased from 1.3% to 0.7% for the time periods compared.

Reference:

• Cram P, Lu X, Kaboli PJ, Vaughan-Sarrazin MS, Cai X, Wolf, BR, Li Y. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008. JAMA. 2011;355(15):1560-1567.
• jama.ama-assn.org
• Disclosure: The authors report no conflicts of interest. Cram reports having received consulting fees from The Consumers Union (publisher of Consumer Reports magazine) and Vanguard Health Inc. for advice provided on quality improvement initiatives.

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