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Early discharge not perceived as an independent risk factor for complications after THA, TKA
Patients with a standard length of stay had an approximate 2.5-fold increase in the rate of transfusion.
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While patient comorbidities and perioperative variables attributed to increased major complications and readmissions after total hip or knee arthroplasty, early discharge was not an independent risk factor for 30-day major complications or readmissions, according to a study.
“The take-home message of the study and what we were trying to show is [within] certain demographics, it is safe to send patients home after a total hip or a total knee without the risk of readmission or major complications that they would have avoided had they stayed in the hospital,”J. Carl Sutton III, MD, a fellow at Detroit Medical Center Sports Medicine, told Orthopedics Today.
Demographics for discharge
Sutton and his colleagues identified 31,044 patients who underwent total knee arthroplasty (TKA) and 19,909 patients who underwent a total hip arthroplasty (THA) between 2011 and 2012 through the National Surgical Quality Improvement Program database. Researchers categorized patients into an early discharge group and a standard discharge group, and compared patient demographics and perioperative variables.
Results showed patients who were younger, had fewer medical comorbidities and had a lower American Society of Anesthesiologists (ASA) score were discharged earlier. Men were also more likely to be discharged early following THA and TKA compared with women. Researchers found an approximate 2.5-fold increase in the transfusion rate among patients with a standard length of stay following THA or TKA.
Although the two groups had no difference in overall rate of major complications following TKA, there were fewer major complications following THA among patients discharged early. Similarly, patients in the early discharge group had lower 30-day readmission rates for both THA and TKA.
Multivariable logistic-regression model showed no association between early discharge and increased odds of major complications following TKA. However, when controlling for all other risk factors, early discharge was an independent predictor against major complications after THA.
Surgeon reassurance
With the length of hospital stays trending downward during the past 2 decades, Sutton noted the trend will probably continue “with regard to patients who are on the healthier side when they have for surgery.” He added the results of this study help reassure surgeons that it may be beneficial to release healthier patients from the hospital earlier after surgery.
“The implications surgeons can take away from this is that if they have patients who are on the younger side, [have a] lower ASA score, [do not have] a lot of medical comorbidities when they have surgery, surgeons can feel comfortable if a patient is ready to go home 1 day or 2 days [postoperatively]. They do not need to keep the patient in the hospital in order to avoid major complications,” Sutton said. – by Casey Tingle
- Reference:
- Sutton 3rd, JC, et al. J Bone Joint Surg Am. 2016;doi:10.2106/JBJS.15.01109.
- For more information:
- J. Carl Sutton III, MD, can be reached at McGill University, 845 Rue Sherbrooke O, Montréal, QC H3A 0G4, Canada; email: jcarlsutton@gmail.com.
Disclosure: Sutton reports no relevant financial disclosures.
Perspective
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Anthony A. Romeo, MD
It is important to understand that outpatient total joint replacement is relatively new for many surgeon practices. Therefore, it is highly likely that they are selecting the healthiest patients with the least likely chance of postoperative problem. This includes areas that are not measured in these large population databases, such as the resolve of the patient and the patients ability to be educated and accept the terms of outpatient surgery logistics. It would not be surprising for the inpatient population to have more complications or needs, such as a higher transfusion rate.
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