title: The 72-Hour Medicare Mandate After Total Joint Arthroplasty: Is This Medically Necessary?
abstract: Currently, Medicare total joint arthroplasty patients are required to stay postoperatively 3 days in the hospital before discharge to a skilled nursing facility (SNF). We evaluated Medicare's mandated 3-night hospital stay rule to find out how many total joint arthroplastic patients are safe for discharge to SNFs on postoperative day 2 (POD2).
  
  
  
  This is a retrospective case series analyzing Medicare primary total hip or total knee arthroplastic patients at a single hospital over 1 year. Patients meeting 15 separate criteria by POD2 were considered safe for discharge home rather than to a SNF.
  
  
  
  Of 259 patients, 47.88% met discharge criteria to SNF POD2. 31.66% did not meet 1, 13.13% did not meet 2, and 6.95% did not meet ≥3 criteria on POD2. Common criteria delaying discharge were blood pressure abnormalities, increasing or elevated white blood cell count, cardiac abnormalities, and fever. Thirty-day readmission rate for patients in the group safe for discharge POD2 was 1.75%.
  
  
  
  Of the total, 47.88% of patients required to stay by the Medicare 3-night stay rule were safe for discharge to SNF on POD2 without an increase in readmission rate at 30 days when compared to our institutional mean.
authors.affiliation: Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Zachary W
authors.initials: ZW
authors.lastname: Sisko
authors.affiliation: Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois.
authors.forename: Min
authors.initials: M
authors.lastname: Lu
authors.affiliation: Department of Orthopaedic Surgery, NorthShore University Health System, Skokie, Illinois.
authors.forename: Lalit
authors.initials: L
authors.lastname: Puri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000331:legislation & jurisprudence / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006760:Hospitalization / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008875:Middle Aged; D010351:Patient Discharge / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011184:Postoperative Period; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States
keywords: 3-night stay rule; Medicare; complications; primary total hip arthroplasty; primary total knee arthroplasty