TORONTO — Over a period of 12 years, hospital readmission rates declined among patients who underwent elective surgery for osteoarthritis, yet emergency department visits rose, according to findings presented here.
Mayilee Canizares, PhD, of the University Health Network in Toronto, Canada, suggested that returning to the hospital within 30 days of discharge after surgery is a parameter commonly used to assess successful transition from hospital to community.
“Since the early 1990s, changes in clinical care, such as shortening length of stay and discharge indications, have been implemented in Canada and across other jurisdictions,” she told attendees at the OARSI 2019 World Congress on Osteoarthritis. “However, there is no consensus as to whether a shorter length of stay and discharge directly to home is associated with returning to hospital or admission to emergency departments.”
The researchers evaluated this information in all patients who underwent elective OA surgery in Ontario between 2004 and 2016.
Results showed that 22,700 patients underwent elective OA surgery in 2004, compared with 31,000 in 2010 and 41,900 in 2016.
“Overall, we found that from 2004 to 2016, there has been a significant increase in the number of all patients undergoing elective orthopedic surgery in Ontario,” Canizares said. “However, length of stay has dropped from about 5 days in 2004 to 3 days in 2016.”
She added that more patients are being discharged home, as opposed to another institution where they can receive post-operative care. Results showed that 30-day readmission rates decreased from 4.2% in 2004 to 3.2% in 2016. However, ED visits increased from 8.7% to 14%.
The next step, then, was to identify factors that could explain these changes, according to Canizares. Results showed that most patient-related variables, including length of hospital stay, did not contribute to these changes over time.
“In the last model, we added discharge disposition,” Canizares said. “We found that this was the main contributor to the changes.”
Discharge disposition explained the changes over time in both outcomes, according to Canizares.
One key limitation of the data set is that it may not be possible to extrapolate the conclusions beyond Ontario, she noted.
“Our study suggests that practices put in place in Ontario, where patients have been discharged sooner and directly to home, have partially explained a decline in readmission rates,” Canizares concluded. “But discharging directly home has negatively impacted emergency department visits after surgery.”
These findings highlight the importance of coordinating support services as well as the need to have ongoing assessment of the optimal discharge care plan for these patients, according to Canizares. “These findings may also be helpful to inform policy decisions pertaining to funding models in OA surgical care,” she said. —by Rob Volansky
Canizares M, et al. Abstract #16. Presented at: OARSI 2019 World Congress on Osteoarthritis; May 2-5; Toronto, Canada.
Disclosure: Canizares reports no relevant financial disclosures.