title: Selective Early Hospital Discharge Does Not Increase Readmission but Unnecessary Return to the Emergency Department Is Excessive Across Groups After Primary Total Knee Arthroplasty.
abstract: There has been much attention paid to the ability to optimize outcomes, limit complications, and reduce costs within the episode of care after total joint arthroplasty. Limiting the duration of postoperative hospitalization as well as reducing emergency department (ED) visits and readmissions are additional considerations in the paradigm of cost containment. Our purpose was to evaluate the safety of early hospital discharge after primary total knee arthroplasty (TKA) and to identify the diagnoses responsible for ED visits and readmissions in the postoperative period.
  
  
  
  We investigated risk factors for readmission in 995 patients undergoing primary TKA. We compared 2 groups: length of hospital stay (LOS) ≤2 or ≥3 days. Analysis included LOS, Charlson score, history of DVT, discharge disposition, and postdischarge ED visits.
  
  
  
  Patients who stayed ≤2 postoperative days had a significantly lower mean Charlson score and more likely discharged home. Charlson score and history of DVT were predictive of return events. Patients discharged to home were less likely to have return events. More than half of the patients evaluated in the ED were not readmitted.
  
  
  
  Among patients undergoing primary TKA, it is the health of the patient, and not their resultant LOS, that correlates to return events. The ED is overused for complaints that may otherwise be managed as effectively and more cost efficiently in outpatient settings. Cost containment must include unnecessary utilization of the ED.
authors.affiliation: Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rossman
authors.affiliation: Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Reb
authors.affiliation: Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Danowski
authors.affiliation: Rothman Institute, Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: Department of Orthopaedic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey.
authors.forename: John K
authors.initials: JK
authors.lastname: Mariani
authors.affiliation: Rothman Institute, Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jess H
authors.initials: JH
authors.lastname: Lonner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D012307:Risk Factors
keywords: arthroplasty; discharge; emergency department; knee; readmission