Outpatient TKA yielded higher readmission rates in Medicare patients vs. inpatient TKA
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CHICAGO — Medicare patients who underwent total knee arthroplasty classified as outpatients had higher readmissions and rates of discharge to nursing facilities than those who had surgery as inpatients, according to results presented here.
Using an administrative claims database, Robert A. Burnett III, MD, and colleagues compared demographics, comorbidities, length of stay, discharge disposition and 90-day medical and surgical complications between Medicare patients who underwent TKA with an inpatient status (n=63,356) to those with an outpatient status (n=38,510) from 2018 to 2020. Researchers also annually trended the classification status of Medicare patients who underwent TKA from 2015 to 2020.
“The outpatient status from 2015 to 2017 was only used for 2,000 patients, while from 2018 to 2020, this increased substantially to 38,000,” Burnett said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Rates of outpatient classification increased from 1.8% for 2015 to 2017 to 57.2% for 2018 to 2020, according to Burnett.
“Looking at comorbidity breakdown amongst groups, we found that outpatient designated patients were not, in fact, healthier than their inpatient cohort and had several comorbidities which were higher,” Burnett said.
Burnett noted patients with outpatient classification had higher rates of discharge to nursing facilities, emergency visits and readmissions. He added 72% of patients with outpatient classification had an extended length of hospital stay, as well as an association with higher rates of several complications at 90-days, including urinary tract infection, acute renal failure and wound complications.
“We need further research to understand which patients are appropriate for outpatient surgery, but until then, we would caution hospitals from using a unanimous coding guideline for Medicare patients who are undergoing total knee arthroplasty,” Burnett said.
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Della Valle CJ, et al. Paper 508. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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