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. 2015 Oct 19;4(1):107-112.
doi: 10.1016/j.artd.2015.08.003. eCollection 2018 Mar.

Is a shortened length of stay and increased rate of discharge to home associated with a low readmission rate and cost-effectiveness after primary total knee arthroplasty?

Steven J Barad  1 , Stephen M Howell  1   2   3 , Joyce Tom  1
Affiliations

Is a shortened length of stay and increased rate of discharge to home associated with a low readmission rate and cost-effectiveness after primary total knee arthroplasty?

Steven J Barad et al. Arthroplast Today. .

Abstract

Background: It is controversial whether shortening the average length of hospital stay and increasing discharge from a rehabilitation facility to home with either health care or outpatient physical therapy is safe and cost-effective.

Methods: We computed the average length of hospital stay; the rate of discharge to a rehabilitation facility, home with health care, or home with outpatient physical therapy; the all-cause readmission rate within 30 days of discharge per year; and cost savings for 2328 consecutive patients treated with a unilateral primary total knee replacement between 2009 and 2014.

Results: The average length of hospital stay per year shortened from 2.0 to 1.3 days (P < .0001); the rate of discharge per year to a rehabilitation facility decreased from 41% to 1% and increased from 9% to 53% to home with outpatient physical therapy (P < .0001); and the rate of readmission within 30 days per year did not change (P = .38). The cost savings averaged $3245 per patient.

Conclusions: A shorter length of hospital stay and an increased rate of discharge to home was not associated with an increased rate of readmission within 30 days and was cost-effective.

Level of evidence: Level IV, Therapeutic study.

Keywords: Discharge to home; Discharge to rehabilitation facility; Length of stay; Rate of readmission; Total knee arthroplasty.

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Figures

Figure 1
Figure 1
Overlay plot shows the average length of hospital stay per year for the hospital in the present study, which is juxtaposed with the 5th, 50th, and 95th percentiles of the 540 (2009) to 700 (2014) comparative hospitals in the national database. From 2009 to 2014, the average length of hospital stay per year in the present study shortened 37% from 2.0 to 1.3 nights (P < .0001) and was shorter than the 5th percentile of the comparative hospitals in the national database. Different letters (A–E) show those years with a change in the average length of hospital stay per year (P < .05).
Figure 2
Figure 2
Overlay plot shows the rate of patients discharged home per year with home health or outpatient physical therapy for the hospital in the present study, which is juxtaposed to the 5th, 50th, and 95th percentiles of the comparative hospitals in the national database. The percentage of patients discharged home per year in the present study increased from 59% in 2009 to 99% in 2014 and was higher than the 95th percentile of the comparative hospitals in the national database from 2010 to 2014. For the hospital in the present study, a value of P < .05 shows consecutive years in which the distribution of patients discharged to rehabilitation facility, home with health care, and home with outpatient physical therapy changed significantly.
Figure 3
Figure 3
Overlay plot shows the all-cause rate of readmission within 30 days of discharge per year for each year for the hospital in the present study, which is juxtaposed to the 20th, 50th, and 95th percentiles of the comparative hospitals in the national database. The annual rate of readmission within 30 days in the present study of 1.3% in 2009 and 0.9% in 2014 did not change (P = .38), and the annual rate of readmission within 30 days was not >10 points above the 20th percentile of the comparative hospitals in the national database.
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