Patients undergoing outpatient total joint arthroplasty had readmission rates, number of emergency room visits and patient satisfaction outcomes comparable patients who underwent inpatient procedures, according to a presenter at the American Academy of Orthopaedic Surgeons Annual Meeting.
“There has been a recent demand in outpatient total joint arthroplasty [TJA] stemming from better protocols, pain management and physical therapy,” Walter B. Beaver Jr., MD, medical director at OrthoCarolina in Charlotte, N.C., said. “The big question is, are there safety concerns with outpatient TJA? And more recently, there are concerns about penalties for readmission.”
According to Beaver and his colleagues, under the Patient Care and Affordability Act, Medicare is focusing on 30-day readmission rates for certain diagnoses and is penalizing hospitals financially for readmissions in this timeframe. “In 2015, [CMS is] probably going to include total hip and total knee arthroplasty in the penalties for readmission, and the penalties may be a maximum of 3%,” Beaver said.
Study inclusion criteria
Beaver and his colleagues sought to determine whether outpatient or inpatient TJA influenced hospital readmission rates during the 30-day postoperative period. They completed telephone surveys with 235 patients, including 137 outpatients and 98 inpatients who underwent TJA at the same institution between September 2010 and May 2011. One surgeon performed all of the outpatient TJAs, and two surgeons who performed the inpatient TJAs, which included hospital stays with a minimum of 2 days.
Criteria for outpatient TJA included a body mass index of less than 40 kg/m2 and no active cardiopulmonary issues, sleep apnea, or history of deep venous thrombosis or pulmonary embolus. Patients also had to live less than 1 hour from the hospital and have good family support.
Readmission rates were 5.7% for inpatient TJA vs. 10.1% for outpatient TJA. “At our cohort size, there was no statistical significance seen,” Beaver said.
When researchers included emergency room visits with readmissions, 6.7% of inpatients and 12.4% of outpatients required unplanned medical care after hospital discharge; again, according to Beaver, this difference was not statistically significant.
Researchers observed no statistically significant differences between the two groups for readmission during the first 4 postoperative days or when stratified by joint: In the inpatient group, seven total knee arthroplasty (TKA) patients and no total hip arthroplasty (THA) patients were readmitted during the 30-day postoperative period, and in the outpatient group, 16 TKA patients and one THA patient were readmitted.
Both patient groups reported high patient satisfaction, with no statistically significant difference between the two groups.
“There was no statistical difference when looking at 30-day hospital readmission rate and patient satisfaction,” Beaver said. “However, there was a higher readmission rate for the outpatient surgery group, which was clinically meaningful. This may have financial implications due to higher readmission rates for the outpatient group. Implications could affect bundled payments in the future, and this is especially true for total knee arthroplasty.”