Hospital Discharge within 2 Days Following Total Hip or Knee Arthroplasty Does Not Increase Major-Complication and Readmission Rates.
BACKGROUND
The rising costs of total knee arthroplasty (TKA) and total hip arthroplasty (THA) have resulted in a substantial economic burden on the U.S. health-care system. Recent efforts to contain these costs have targeted hospital length of stay. However, shorter hospital admissions have raised concerns over possible increases in complications and readmission rates. The purpose of this study was to assess whether early discharge, from 0 to 2 days postoperatively, was associated with increased 30-day major complications and readmissions compared with standard discharge, 3 to 4 days following THA or TKA.


METHODS
The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent an elective, primary unilateral THA or TKA between 2011 and 2012. For each procedure, 2 groups were created consisting of patients discharged from 0 to 2 days (early discharge) and those discharged from 3 to 4 days (standard discharge). Patient demographics and perioperative variables were compared between both discharge groups. Multivariable logistic-regression models were used to assess the independent effect of length of stay on 30-day major-complication and readmission rates.


RESULTS
A total of 31,044 patients who underwent TKA and 19,909 patients who underwent THA were included. Overall, patients who were discharged early were younger and had fewer medical comorbidities and a lower American Society of Anesthesiologists (ASA) score. The multivariable logistic-regression model revealed that early discharge was not associated with increased odds of major complications following TKA (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.75 to 1.20; p = 0.64). Furthermore, early discharge following THA was found to be an independent predictor against major complications (OR = 0.75; 95% CI = 0.58 to 0.95; p = 0.02). Lastly, early discharge was not an independent risk factor for hospital readmission following THA or TKA.


CONCLUSIONS
Early discharge was not an independent risk factor for 30-day major complications or readmissions following THA or TKA. Rather, increased major complications and readmissions were attributed to patient comorbidities and perioperative variables. Early discharge within the first 2 days postoperatively for risk-stratified patients appears feasible without compromising patient care.


METHODS
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada joseph.sutton@mail.mcgill.ca.
J Carl
JC
Sutton
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada janton@orl.mcgill.ca.
John
J
Antoniou
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada ld_epure@yahoo.com.
Laura M
LM
Epure
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada olgahuk@gmail.com.
Olga L
OL
Huk
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada david.zukor@mcgill.ca.
David J
DJ
Zukor
Department of Orthopaedic Surgery, Jewish General Hospital, Montreal, Quebec, Canada stephane.bergeron@mail.harvard.edu.
Stephane G
SG
Bergeron
D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors