Data show safety of discharging Medicare patients the day following TKR in a community setting

ORLANDO, Fla. — 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, according to Gregory G. Klingenstein, MD, a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.

“Our results support the hypothesis that a 1-day length of stay does not increase the risk of readmission,” he said.

Without using risk stratification, Klingenstein and colleagues used a typical rapid discharge protocol for 2,064 Medicare patients scheduled for unilateral total knee replacement (TKR). The length of stay, in general, for these patients was 2 days and 54% of the patients went home the day after surgery. The researchers found 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 used in the 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.

An analysis the investigators did on readmission showed length of stay was the only factor that was statistically significant for readmission within 30 days.

“In fact, for patients who went home the day after surgery, they were 53% less likely to be readmitted, even after controlling for medical comorbidities,” Klingenstein said.

“To our knowledge this is the first community-based paper on this topic. Most of the prior studies have been from academic centers,” he said. – by Susan M. Rapp

Reference:

Klingenstein GG, et al. Paper #668. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Klingenstein reports no relevant financial disclosures.