Barad Steven J, Howell Stephen M, Tom Joyce
Methodist Hospital, Sacramento, CA, USA.
Biomedical Engineering Graduate Group, University of California, Davis, CA, USA.
Arthroplast Today. 2015 Oct 19;4(1):107-112. doi: 10.1016/j.artd.2015.08.003. eCollection 2018 Mar.
It is controversial whether shortening the average length of hospital stay and increasing discharge from a rehabilitation facility to home with either health care or outpatient physical therapy is safe and cost-effective.
We computed the average length of hospital stay; the rate of discharge to a rehabilitation facility, home with health care, or home with outpatient physical therapy; the all-cause readmission rate within 30 days of discharge per year; and cost savings for 2328 consecutive patients treated with a unilateral primary total knee replacement between 2009 and 2014.
The average length of hospital stay per year shortened from 2.0 to 1.3 days (P < .0001); the rate of discharge per year to a rehabilitation facility decreased from 41% to 1% and increased from 9% to 53% to home with outpatient physical therapy (P < .0001); and the rate of readmission within 30 days per year did not change (P = .38). The cost savings averaged $3245 per patient.
A shorter length of hospital stay and an increased rate of discharge to home was not associated with an increased rate of readmission within 30 days and was cost-effective.
Level IV, Therapeutic study.
缩短平均住院时间以及增加从康复机构出院回家并接受医疗保健或门诊物理治疗是否安全且具有成本效益存在争议。
我们计算了2009年至2014年间连续接受单侧初次全膝关节置换术治疗的2328例患者的平均住院时间；出院至康复机构、回家接受医疗保健或回家接受门诊物理治疗的比例；每年出院后30天内的全因再入院率；以及成本节约情况。
每年平均住院时间从2.0天缩短至1.3天（P <.0001）；每年出院至康复机构的比例从41%降至1%，而出院回家接受门诊物理治疗的比例从9%增至53%（P <.0001）；每年30天内的再入院率未发生变化（P =.38）。每位患者平均节约成本3245美元。
缩短住院时间和增加出院回家的比例与30天内再入院率增加无关，且具有成本效益。
IV级，治疗性研究。
