Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopaedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
Arch Orthop Trauma Surg. 2024 Aug;144(8):3851-3856. doi: 10.1007/s00402-024-05502-3. Epub 2024 Aug 22.
Following removal of total hip arthroplasty (THA) from the inpatient only (IPO) list by the Center for Medicare Services (CMS), arthroplasty surgeons face increased pressure to perform procedures on an outpatient (OP) basis. The purposes of the present study were to compare patients booked for THA as OP who required conversion to IP status postoperatively, to patients who were booked as, and remained OP, and to identify factors predictive of conversion from OP to IP status.
We retrospectively reviewed all patients who underwent a primary THA at our institution between January 1, 2020 and April 26, 2022. All patients included were originally scheduled for OP surgery and were separated based on conversion to IP status postoperatively. Multiple regression analyses were used to determine the significance of all perioperative variables. Modeling via binary logistic regressions were used to determine factors predictive of status conversion.
Of 1,937 patients, 372 (19.2%) designated as OP preoperatively required conversion to IP status postoperatively. These patients had significantly higher facility discharge rates (P < 0.001) and 90-day readmission rates (P = 0.024). Patients aged 65 and older (P < 0.001), females (P < 0.001), patients with Black/African American race (P = 0.027), with a recovery room arrival time after 12 pm (P < 0.001), with a BMI > 30 kg/m2 (P = 0.001), and with a Charlson Comorbidity Index (CCI) ≥ 4 (P = 0.013) were Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation more likely to require conversion to IP designation. Marital status and time of procedure were also significant factors, as patients who were married (P < 0.001) and who were the first case of the day (P < 0.001) were less likely to be converted to IP.
Several factors were identified which could help determine appropriate hospital designation status at the time of surgical booking to ultimately avoid insurance claim denials. These included BMI, certain demographic factors, CCI ≥ 4, and patients 65 or older.
Retrospective Cohort Study.
在医疗保险服务中心（CMS）将全髋关节置换术（THA）从仅限住院患者（IPO）名单中移除后，关节置换外科医生面临着更大的压力，需要在门诊（OP）基础上进行手术。本研究的目的是比较最初预定为 OP 并在术后需要转为 IP 状态的 THA 患者，与最初预定为 OP 且仍保持 OP 状态的患者，并确定从 OP 转为 IP 状态的预测因素。
我们回顾性分析了 2020 年 1 月 1 日至 2022 年 4 月 26 日期间在我院接受初次 THA 的所有患者。所有纳入的患者最初均计划接受 OP 手术，并根据术后是否转为 IP 状态进行分组。多变量回归分析用于确定所有围手术期变量的意义。通过二项逻辑回归模型来确定状态转换的预测因素。
在 1937 名患者中，有 372 名（19.2%）术前被指定为 OP，但术后需要转为 IP 状态。这些患者的医疗机构出院率显著更高（P<0.001），90 天内再入院率也更高（P=0.024）。年龄在 65 岁及以上的患者（P<0.001）、女性（P<0.001）、非裔美国人（P=0.027）、恢复室到达时间为 12 点以后（P<0.001）、BMI>30kg/m2（P=0.001）、Charlson 合并症指数（CCI）≥4（P=0.013）的患者更有可能需要转为 IP 状态。婚姻状况和手术时间也是重要的影响因素，已婚患者（P<0.001）和当天第一例手术患者（P<0.001）转为 IP 的可能性较低。
有几个因素可以帮助确定手术预约时的适当医院指定状态，以最终避免保险索赔被拒。这些因素包括 BMI、某些人口统计学因素、CCI≥4 和 65 岁及以上的患者。
III 级回顾性队列研究。
