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The Journal of Hip Surgery 2021; 05(04): 152-164
DOI: 10.1055/s-0041-1735889
Original Article

Complications and Unsuccessful Same-Day Discharge Following Outpatient Total Hip Arthroplasty (THA) in the Medicare Population: Incidence, Risk Factors, and Clinical Impact

Adam M. Gordon
1   Department of Orthopaedic Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin
,
Azeem Tariq Malik
2   Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
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Abstract

In 2020, total hip arthroplasty (THA) was removed from the inpatient-only list by the Centers for Medicare and Medicaid Services. The objective was to analyze outpatient THA in the Medicare population to understand incidence of failed same-day discharge (SDD) and risk factors for complications and extended length of stay (LOS). The 2015–2019 American College of Surgeons—National Surgical Quality Improvement Program database was queried for Medicare patients (≥ 65 years) undergoing outpatient THA. Short-term complications, LOS, and discharge destination were evaluated. Multivariate logistic regression was used to evaluate risk factors for complications, failed SDD, reoperation, readmission, and non-home discharge disposition. Overall, 2,063 THAs were included. Complication rate was 7.4%. The number of patients staying in the hospital ≥ 1 day was 1,080 (52%). A total of 151 patients (7.3%) experienced a non-home discharge. Predictors for having any complication was an extended LOS ≥ 1 day (odds ratio [OR] 2.86), p < 0.001. Significant predictors for failed SDD were smoking history (OR 2.25), operative time ≥ 82 minutes (OR 1.98), American Society of Anesthesiologists Class > II (OR 1.67), and age ≥ 71 (OR 1.31) (all p ≤ 0.004). Significant predictors for a non-home discharge were LOS ≥ 1 day (OR 13.71), American Society of Anesthesiologists Class > II (OR 2.36), age ≥ 71 (OR 2.07), operative time ≥ 82 minutes (OR 1.88), and female gender (OR 1.81), all p ≤ 0.003. The current study identifies the incidence, risk factors, and clinical impact of postoperative complications and prolonged LOS in Medicare-aged patients undergoing outpatient THA. Providers should consider preoperatively risk stratifying patients to reduce the costs associated with extended LOS, complication, and unplanned discharge destination.

Keywords

NSQIP - total joint arthroplasties - complications - total hip arthroplasty - same day discharge - total hip arthroplasty

Disclosure

The authors received no funding for this study.


Ethical Committee Statement

This study did not require approval from the Institutional Review Board of Medical College of Wisconsin or The Ohio State University.




Publication History

Received: 05 May 2021

Accepted: 18 August 2021

Article published online:
17 September 2021

© 2021. Thieme. All rights reserved.

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