PROVIDENCE, R.I. — Among patients who underwent total joint arthroplasty required to follow the Medicare 72-hour-stay rule, 47.88% were safe for discharge to a skilled nursing facility by postoperative day 2, according to results presented at the American Orthopaedic Association Annual Meeting.
“What our data have shown [is] a good proportion of our Medicare postop total joint patients are actually medically safe for discharge after 2 nights rather than after a 3-night stay,” Zachary Sisko, MD, an orthopedic surgery resident at the University of Chicago, told Healio.com/Orthopedics.
Sisko and colleagues retrospectively reviewed 259 patients who underwent total joint arthroplasty (TJA) during a 1-year period. To be included in the study, patients had to have underwent primary TJA with Medicare as their primary payer and had a length of stay of 3 or more nights before admission into a skilled nursing facility. To be considered safe for admission into a skilled nursing facility, patients were required to meet 14 medical criteria by postoperative day 2.
According to the results, 47.88% of patients met discharge criteria to a skilled nursing facility by postoperative day 2, whereas 31.66% of patients did not meet one discharge criteria, 13.13% did not meet two discharge criteria and 6.95% did not meet three or more discharge criteria.
The researchers found blood pressure abnormalities requiring medical management was the most common criteria delaying discharge (12.36%), followed by cardiac arrhythmia/myocardial infarction that required further work-up or monitoring (10.42%), temperature higher than 100.5° F (9.65%) and electrolyte disturbances (8.88%).
“If anything, there are further studies that we need to look at to see which of these patients end up getting readmitted and if there are any predictive factors preoperatively that we can identify for these patients that would make them more likely to be safely discharged by postop day 2 rather than postop day 3,” Sisko said. – by Casey Tingle
Sisko Z, et al. Poster #42. Presented at: American Orthopaedic Association Annual Meeting; June 24-27, 2015; Providence, R.I.
Disclosure: Sisko reports no relevant financial disclosures.