title: Do shorter lengths of stay increase readmissions after total joint replacements?
abstract: BACKGROUND
  Enhanced recovery after surgery protocols for total joint replacements (TJRs) emphasize early discharge, yet the impact on readmissions is not well documented. We evaluate the impact of a one-day length of stay (LOS) discharge protocol on readmissions.
  
  
  METHODS
  We conducted a retrospective review of all primary TJRs (hip and knee) from April 2014 to March 2015. Patients who had adequate support to be discharged home were categorized into 2 groups, 1-day (n = 174) vs 2-day (n = 285) LOS groups. Patients discharged to rehabilitation were excluded (n = 196).
  
  
  RESULTS
  Patients in the 1 day group were more likely to be younger (61.7 vs 64.8 years,P< .001), be male (56.3% vs 40.4%,P= .001), and have a lower body mass index (30.0 vs 31.4 kg/m2,P= .012). One-day LOS patients had shorter surgical times (79.7 vs 85.6 minutes,P= .001) and more likely had spinal anesthesia (46.0% vs 31.2%,P= .001). The overall 30-day all-cause (2.3% vs 2.5%,P= .591) and 90-day wound-related (1.1% vs 1.1%,P= .617) readmission rates were equivalent between groups.
  
  
  CONCLUSIONS
  Early discharge does not increase readmissions and may help attenuate costs associated with TJRs. Further refinement of protocols may allow for more patients to be safely discharged on postoperative day 1.
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Udai S
authors.initials: US
authors.lastname: Sibia
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Kip A
authors.initials: KA
authors.lastname: Waite
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Maura A
authors.initials: MA
authors.lastname: Callanan
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Adrian E
authors.initials: AE
authors.lastname: Park
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: King
authors.affiliation: Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: James H
authors.initials: JH
authors.lastname: MacDonald
keywords: Complications; Enhanced recovery after surgery; Length of stay; Readmissions; Total joint replacement