Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, NC.
Department of Orthopaedics, Medical University of South Carolina, Charleston, SC.
J Arthroplasty. 2020 Feb;35(2):303-308.e1. doi: 10.1016/j.arth.2019.08.059. Epub 2019 Sep 5.
Length of stay (LOS) following total joint arthroplasty (TJA) continues to decrease. The effects of this trend on readmission risk and total cost are unclear. We hypothesize that optimal LOS following TJA minimizes index hospitalization, early readmission risk, and total cost.
Retrospective data from the South Carolina Department of Revenue and Fiscal Affairs was reviewed for patients who underwent primary TJA in South Carolina from 2000 to 2015 (n = 172,760). Data for readmissions within 90 days were included. Severity of illness was estimated by Elixhauser score (EH). Index LOS is defined as the surgery and the subsequent hospital stay.
Patients with more significant medical comorbidities (EH ≥ 4) had significantly longer LOS than healthier patients (4.0 vs 3.4 days, P < .001). Independent of EH, readmitted patients had a significantly longer index LOS than those never readmitted (4.3 vs 3.6 days, P < .001). For healthier patients (EH ≤ 3), each additional inpatient day increased readmission risk, while among sicker patients, staying 2 days vs 1 day was protective against readmission risk. Since 2000, the total index cost of TJA has doubled and average cost per inpatient day has tripled, but readmission rates remain essentially unchanged (7.4% to 7.0%).
Increased LOS was associated with increased readmission risk. Patients with greater medical comorbidities stay longer to protect against readmission. Optimal LOS after TJA is highly influenced by the patient's overall health. Despite a 300% increase in TJA daily cost, readmission rate has changed minimally over the last 15 years.
全关节置换术（TJA）后的住院时间（LOS）持续缩短。这种趋势对再入院风险和总成本的影响尚不清楚。我们假设 TJA 后最佳的 LOS 可以最大限度地减少索引住院、早期再入院风险和总成本。
回顾了 2000 年至 2015 年南卡罗来纳州税收和财政事务部的南卡罗来纳州接受初次 TJA 的患者的回顾性数据（n=172760）。包括 90 天内再入院的数据。疾病严重程度通过 Elixhauser 评分（EH）估计。索引 LOS 定义为手术和随后的住院治疗。
患有更严重的合并症（EH≥4）的患者的 LOS 明显长于健康患者（4.0 天 vs 3.4 天，P<.001）。独立于 EH，再入院患者的索引 LOS 明显长于从未再入院的患者（4.3 天 vs 3.6 天，P<.001）。对于健康患者（EH≤3），每增加一天住院天数会增加再入院风险，而对于病情较重的患者，住院 2 天比 1 天更能降低再入院风险。自 2000 年以来，TJA 的总索引成本翻了一番，每住院一天的平均成本增加了两倍，但再入院率基本保持不变（7.4%至 7.0%）。
增加 LOS 与增加再入院风险相关。患有更多合并症的患者需要延长住院时间以防止再入院。TJA 后最佳 LOS 高度受患者整体健康状况的影响。尽管 TJA 每日成本增加了 300%，但在过去 15 年中，再入院率变化不大。
