Gordon Adam M, Malik Azeem Tariq, Khan Safdar N
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Geriatr Orthop Surg Rehabil. 2021 Feb 8;12:2151459321991500. doi: 10.1177/2151459321991500. eCollection 2021.
The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only (IO) list in January 2020. Given this recommendation, we analyzed Medicare-eligible patients undergoing outpatient THA to understand risk factors for nonroutine discharge, reoperations, and readmissions.
The 2015-2018 American College of Surgeons-National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27130 for Medicare eligible patients (≥ 65 years of age) undergoing outpatient THA. Postoperative discharge destination was categorized into home and non-home. Multivariate logistic regression models were used to evaluate risk factors associated with non-home discharge disposition. Secondarily, we evaluated rates and risk factors associated with 30-day reoperations and readmissions.
A total of 1095 THAs were retrieved for final analysis. A total of 108 patients (9.9%) experienced a non-home discharge postoperatively. Patients were discharged to rehab (n = 47; 4.3%), a skilled care facility (n = 47; 4.3%), a facility that was "home" (n = 8; 0.7%), a separate acute care facility (n = 5; 0.5%), or an unskilled facility (n = 1; 0.1%). Independent factors for a non-home discharge were American Society of Anesthesiologists Class >II (odds ratio [OR] 2.74), operative time >80 minutes (OR 2.42), age >70 years (OR 2.20), and female gender (OR 1.67). Eighteen patients (1.6%) required an unplanned reoperation within 30 days. A total of 40 patients (3.7%) required 30-day readmissions, with 35 readmissions related to the original THA procedure. Independent risk factors for 30-day reoperation were COPD (OR 5.85) and HTN (OR 5.24). Independent risk factors for 30-day readmission were HTN (OR 4.35) and Age >70 (OR 2.48).
The current study identifies significant predictors associated with a non-home discharge, reoperation, and readmission in Medicare-aged patients undergoing outpatient THA.
Providers should consider preoperatively risk-stratifying patients to reduce the costs associated with unplanned discharge destination, complication or reoperation.
医疗保险和医疗补助服务中心于2020年1月将全髋关节置换术（THA）从仅住院（IO）列表中移除。基于这一建议，我们分析了符合医疗保险条件且接受门诊THA的患者，以了解非常规出院、再次手术和再入院的风险因素。
使用当前手术操作术语代码27130查询2015 - 2018年美国外科医师学会 - 国家外科质量改进计划数据库，以获取符合医疗保险条件（≥65岁）且接受门诊THA的患者信息。术后出院目的地分为回家和非回家。使用多因素逻辑回归模型评估与非回家出院处置相关的风险因素。其次，我们评估了30天内再次手术和再入院的发生率及风险因素。
共检索到1095例THA进行最终分析。共有108例患者（9.9%）术后未回家出院。患者被转至康复机构（n = 47；4.3%）、熟练护理机构（n = 47；4.3%）、“家”所在机构（n = 8；0.7%）、独立急性护理机构（n = 5；0.5%）或非熟练护理机构（n = 1；0.1%）。非回家出院的独立因素包括美国麻醉医师协会分级>II级（比值比[OR]2.74）、手术时间>80分钟（OR 2.42）、年龄>70岁（OR 2.20）和女性（OR 1.67）。18例患者（1.6%）在30天内需要进行计划外再次手术。共有40例患者（3.7%）需要30天内再入院，其中35例再入院与原THA手术相关。30天内再次手术的独立风险因素为慢性阻塞性肺疾病（COPD，OR 5.85）和高血压（HTN，OR 5.24）。30天内再入院的独立风险因素为高血压（OR 4.35）和年龄>70岁（OR 2.48）。
本研究确定了在接受门诊THA的医疗保险年龄患者中，与非回家出院、再次手术和再入院相关的重要预测因素。
医疗服务提供者应在术前考虑对患者进行风险分层以降低与计划外出院目的地、并发症或再次手术相关的成本。
