title: Current Evidence Does Not Support Medicare's 3-Day Rule in Primary Total Joint Arthroplasty.
abstract: Patients who undergo total joint arthroplasty and are destined for discharge to an extended-care facility--particularly Medicare beneficiaries--are required to have an inpatient stay of at least 3 consecutive days. The primary objective of this study was to explore the effect of this policy on length of stay. Secondary outcomes were 30-day readmission rate and inpatient rehabilitation gains. We retrospectively reviewed 284 consecutive cases of patients who underwent primary total hip or knee arthroplasty and were discharged to an extended-care facility. Based on readiness-for-discharge criteria, delaying discharge until postoperative day 3 increased length of stay by 1.08 days (P < .001) and had no effect on risk for 30-day readmission (P = .073). Although rehabilitation status improved with stays past discharge readiness (P = .038), the gains were not clinically sufficient to affect discharge destination. This study calls into question the validity of Medicare's 3-day rule in primary total joint arthroplasty. Larger, prospective, multicenter studies are needed to confirm these findings.
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC. mohamad.halawi@dm.duke.edu.
authors.forename: Mohamad J
authors.initials: MJ
authors.lastname: Halawi
authors.forename: Tyler J
authors.initials: TJ
authors.lastname: Vovos
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Green
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wellman
authors.forename: David E
authors.initials: DE
authors.lastname: Attarian
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bolognesi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation*; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D014481:United States