Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA.
Department of Medicine, Northwestern University, Chicago, IL, USA.
J Arthroplasty. 2020 Jul;35(7):1776-1783.e1. doi: 10.1016/j.arth.2020.02.051. Epub 2020 Feb 28.
In November 2019, Centers for Medicare and Medicaid Services announced total hip arthroplasty (THA) will be removed from the inpatient-only list. This may lead to avoidance of patients who have prolonged hospitalizations and discharge to skilled nursing facilities or push providers to unsafely push patients to outpatient surgery centers. Disparities in hip arthroplasty may worsen as patients are "risk stratified" preoperatively to minimize cost outliers. We aimed to evaluate which patient characteristics are associated with extended length of stay (eLOS)-greater than 2 days-and nonhome discharge in patients undergoing hip arthroplasty.
The Illinois COMPdata administrative database was queried for THA admissions from January 2016 to June 2018. Variables included age, sex, race and ethnicity, median household income, Illinois region, insurance status, principal diagnosis, Charlson comorbidity index, obesity, discharge disposition, and LOS. Hospital characteristics included bundled payment participation and arthroplasty volume. Using multiple Poisson regression, we examined the association between these factors and the likelihood of nonhome discharge and eLOS.
There were 41,832 THA admissions from January 2016 to June 2018. A total of 36% had LOS greater than 2 midnights and 25.3% of patients had nonhome discharges. Female patients, non-Hispanic black patients, patients older than 75, obese patients, Medicaid or uninsured status, Charlson comorbidity index > 3, and hip arthroplasty for fracture were associated with increased risk of eLOS and/or nonhome discharge (P < .05).
With the Centers for Medicare and Medicaid Services emphasis on cost containment, patients at risk of extended stay or nonhome discharge may be deemed "high risk" and have difficulty accessing arthroplasty care. These are potentially vulnerable groups during the transition to the bundled payment model.
2019 年 11 月，医疗保险和医疗补助服务中心宣布将全髋关节置换术（THA）从仅限住院治疗的清单中移除。这可能导致那些住院时间延长并出院到熟练护理机构的患者被回避，或者促使提供者不安全地将患者推向门诊手术中心。随着患者在术前被“风险分层”以最大限度地降低成本异常值，髋关节置换术的差异可能会恶化。我们旨在评估哪些患者特征与髋关节置换术患者的延长住院时间（eLOS）-超过 2 天-和非家庭出院相关。
从 2016 年 1 月至 2018 年 6 月，伊利诺伊州 COMPdata 行政数据库中查询了 THA 入院患者。变量包括年龄、性别、种族和民族、家庭收入中位数、伊利诺伊州地区、保险状况、主要诊断、Charlson 合并症指数、肥胖、出院处置和 LOS。医院特征包括捆绑支付参与和关节置换量。使用多泊松回归，我们检查了这些因素与非家庭出院和 eLOS 可能性之间的关联。
2016 年 1 月至 2018 年 6 月期间共有 41832 例 THA 入院。共有 36%的患者 LOS 超过 2 个午夜，25.3%的患者非家庭出院。女性患者、非西班牙裔黑人患者、年龄大于 75 岁的患者、肥胖患者、医疗补助或无保险状态、Charlson 合并症指数>3 以及髋部骨折的髋关节置换术与 eLOS 和/或非家庭出院的风险增加相关（P<0.05）。
随着医疗保险和医疗补助服务中心对成本控制的重视，有延长住院时间或非家庭出院风险的患者可能被视为“高风险”，并难以获得关节置换护理。在向捆绑支付模式过渡期间，这些可能是弱势群体。
