This article is more than 5 years old. Information may no longer be current.
Longer length of hospital stay associated with higher costs, complications following TKA
Click Here to Manage Email Alerts
SAN FRANCISCO — Patients with extended hospital stays following total knee arthroplasty were at higher risk for mortality, revision and other complications, according to a study presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
“It is well known that knee arthroplasty and the demand for total knee arthroplasty (TKA) is going to increase over the next 20 years,” Scott T. Lovald, PhD, MBA, said in his presentation. “Due to this, hospitals will certainly continue to optimize the efficiency with which they deliver this treatment. One way to do this is to decrease the length of stay for patients after surgery.”
Lovald and his group used the Medicare 5% limited data sets to identify patients who underwent TKA between 1997 and 2009, according to the study abstract. These patients were separated into five groups: outpatient (2,883); 1-day inpatient (1,374); 2-day inpatient (6,756); 3- to 4-day inpatient (73,498) and 5-plus day inpatient (23,534). Mortality, readmission, revision, common complications and average annual payments adjusted to Jan. 2011 dollar figures were all taken into account. Results from examinations of costs and risk ratios were compared at 90 days, 1 year and 2 years postoperatively.
According to the study abstract, when compared with the traditional 3- to 4-day stay, incremental payments for osteoarthritis attributable costs at the 2-year postoperative mark were: -$6,964 (outpatient); -$3,327 (1-day); -$1,681 (2-day) and +$1,159 (5-plus day).
At the 1-year postoperative mark, the outpatient group was reported by Lovald to have less pain and stiffness when compared with the traditional stay group — but they also displayed a higher risk of 90-day infection, dislocation, readmission and mortality. There was less pain in the 1-day group, but a higher mortality and revision risk at the 1-year mark. Higher risks for dislocation, implant loosening, mortality and revision were found in the 2-day group at the 1-year mark.
Reductions in cost in the groups with shorter stays were countered by increased revision and mortality risks, but Lovald noted the shorter stay groups displayed improvements in associated pain and stiffness. Further, the 5-plus day group reportedly had the highest costs, as well as the highest risks for mortality, revision and other complications.
“Our short stay group is associated with less pain and stiffness, and also reduced costs — and, in some cases, higher risk for complications, revision and mortality,” Lovald concluded. “The 5-plus day group, pretty much all around, had higher costs, risk of mortality, revision, readmission and other complications.”
Reference:
- Lovald ST, Malkani AL, Lau E, et al. Outpatient total knee arthroplasty: A cost and outcomes analysis. Paper 411. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-10. San Francisco.
- Disclosure: Lovald is a paid consultant for Exponent. Funding for the study was provided by Stryker Orthopaedics.
Follow
OrthoSuperSite.com on Twitter