Hospital re-admission rates after TKA are not influenced by reduced length of stay
“We found no association between decreasing length of stay and re-admission.” James I. Huddleston III, MD, principal investigator of the study and assistant professor of orthopedic surgery at Stanford University Medical Center, said. “Cardiac complications were the most common causes for re-admission, and this represents an opportunity to improve patient safety and reduce costs.”
Two time periods
Using data from the Medicare Patient Safety Monitoring System, Huddleston and colleagues found that the mean length of hospital stay for patients undergoing total knee arthroplasty significantly decreased from 4.1 days between 2002 and 2004, to 3.8 days from 2005 to 2007. However, they discovered 30-day re-admission rates of 5.5% from 2002 to 2004 and 5.8% from 2005 to 2007, which showed no significant difference.
The study, which was presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons, divided patients into two distinct re-admission time periods (2002 to 2004 and 2005 to 2007) because of subtle changes in demographics, such as the rates of chronic obstructive pulmonary disease decreasing during the 6-year period, whereas the rates of diabetes and obesity increased.
Huddleston conceived the study while serving as a technical expert on a panel for the Medicare Patient Safety Monitoring System, which collected data from 2002-2007. The project was funded by the Agency for Healthcare Research and Quality through the Department of Health and Human Services. During that time, Huddleston noted that the rate of adverse events for patients in-hospital dropped from 6.5% for 2002 to 2004, to 3.1% for the period spanning 2005 to 2007.
“Much to our surprise, we noticed a significant trend downward for all adverse events,” Huddleston told Orthopedics Today.
During the 6-year study, the investigators discovered an overall 30-day re-admission rate of 5.6%. In total, 55% of patients readmitted to the hospital after discharge were for cardiac complications, such as congestive heart failure, chronic ischemic heart disease, cardiac dysrhythmias and acute myocardial infarction.
“Therefore, as a precaution, we recommend a routine follow-up with the patient’s primary care physician and/or cardiologist if they have one, within 2 to 4 weeks of discharge,” Huddleston said. Implementing a lower threshold for cardiac stress testing before surgery may also help.
Huddleston also pointed to data from Denmark, which has implemented a perioperative fast-track program. Consequently, “the hospital stay of a patient in Denmark has been significantly reduced,” he said. “In general, such a program is under the umbrella of clinical pathways, where you try to reduce all variability in the preoperative, perioperative and postoperative care.” – by Bob Kronemeyer
- Huddleston III JI, Wang Y, Herndon JH, et al. Re-admission and length of stay after TKA in a national Medicare sample 2002-2007. Paper #586. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
- James I. Huddleston III, MD, can be reached at Stanford Medicine Outpatient Center, Orthopedic Surgery — North Campus, 450 Broadway St., Pavilion C, 4th Floor MC 6342, Redwood City, CA 94063; 650-721-7661; email: firstname.lastname@example.org.
- Disclosure: Huddleston receives research support from Biomet and is a consultant for Biomet, Zimmer, Smith & Nephew and Porosteon. He also has stock options in Porosteon.