Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care

This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  • A significantly higher proportion of patients who had an outpatient TJA reported that they received excellent care the day of their surgery.

  • A significantly higher proportion of patients who had an outpatient TJA reported that they received excellent care the day of their surgery.

  • Of the 243 patients included in the study, 166 underwent primary TKA, and 77 underwent primary THA. All inpatient and outpatient TKAs were performed using spinal or general anesthesia, a medial parapatellar approach, and included perioperative multimodal pain management. All inpatient and outpatient THAs were performed under spinal or general anesthesia at the discretion of the anesthesiologist. A standard posterior lateral approach and included perioperative multimodal pain management, which included nonsteroidal anti-inflammatories, oral acetaminophen, short-acting oral narcotics, and either local periarticular joint injection or peripheral nerve blocks were utilized. Fig. 1 illustrates the breakdown of the study sample.

    Fig. 1

    Study sample.


    1. 1. Fehring T.K., Odum S.M., Troyer J.L., et al: Joint replacement access in 2016: a supply side crisis. J Arthroplasty 2010; 25: pp. 1175-1181

    2. 2. Healy W.L., Iorio R., Ko J., et al: Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Joint Surg Am 2002; 84-A: pp. 348-353

    3. 3. Berger R.A.: A comprehensive approach to outpatient total hip arthroplasty. Am J Orthop (Belle Mead NJ) 2007; 36: pp. 4-5

    4. 4. Berger R.A., Sanders S.A., Thill E.S., et al: Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res 2009; 467: pp. 1424-1430

    5. 5. Berend K.R., Lombardi A.V., and Mallory T.H.: Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int 2004; 13: pp. 239-247

    6. 6. Berger R.A., Jacobs J.J., Meneghini R.M., et al: Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 2004; undefined: pp. 239-247

    7. 7. Healy W.L., Ayers M.E., Iorio R., et al: Impact of a clinical pathway and implant standardization on total hip arthroplasty: a clinical and economic study of short-term patient outcome. J Arthroplasty 1998; 13: pp. 266-276

    8. 8. Peters C.L., Shirley B., and Erickson J.: The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty 2006; 21: pp. 132-138

    9. 9. Clement R.C., Derman P.B., Graham D.S., et al: Risk factors, causes, and the economic implications of unplanned readmissions following total hip arthroplasty. J Arthroplasty 2013; 28: pp. 7-10

    10. 10. Cram P., Lu X., Kates S.L., et al: Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308: pp. 1227-1236

    11. 11. Wolf B.R., Lu X., Li Y., et al: Adverse outcomes in hip arthroplasty: long-term trends. J Bone Joint Surg Am 2012; 94: pp. e103

    12. 12. Lovald S.T., Ong K.L., Malkani A.L., et al: Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014; 29: pp. 510-515

    13. 13. Berger R.A., Sanders S., D’Ambrogio E., et al: Minimally invasive quadriceps-sparing TKA: results of a comprehensive pathway for outpatient TKA. J Knee Surg 2006; 19: pp. 145-148

    14. 14. Kolisek F.R., McGrath M.S., Jessup N.M., et al: Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res 2009; 467: pp. 1438-1442

    15. 15. Dorr L.D., Thomas D.J., Zhu J., et al: Outpatient total hip arthroplasty. J Arthroplasty 2010; 25: pp. 501-506

    16. 16. Avram V., Petruccelli D., Winemaker M., et al: Total joint arthroplasty readmission rates and reasons for 30-day hospital readmission. J Arthroplasty 2014; 29: pp. 465-468

    17. 17. Mesko N.W., Bachmann K.R., Kovacevic D., et al: Thirty-day readmission following total hip and knee arthroplasty – a preliminary single institution predictive model. J Arthroplasty 2014; 29: pp. 1532-1538

    18. 18. Saucedo J.M., Marecek G.S., Wanke T.R., et al: Understanding readmission after primary total hip and knee arthroplasty: who’s at risk? J Arthroplasty 2014; 29: pp. 256-260

    19. 19. Schairer W.W., Sing D.C., Vail T.P., et al: Causes and frequency of unplanned hospital readmission after total hip arthroplasty. Clin Orthop Relat Res 2014; 472: pp. 464-470

    20. 20. Bohm E.R., Dunbar M.J., Frood J.J., et al: Rehospitalizations, early revisions, infections, and hospital resource use in the first year after hip and knee arthroplasties. J Arthroplasty 2012; 27: pp. 232-237.e1

    21. 21. Vorhies J.S., Wang Y., Herndon J., et al: Readmission and length of stay after total hip arthroplasty in a national Medicare sample. J Arthroplasty 2011; 26: pp. 119-123

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    Feb 23, 2017 | Posted by in ORTHOPEDIC | Comments Off on Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care
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