Early and Direct Rehab Transfer Leads to Significant Cost Savings and Decreased Hospital Length of Stay for Total Joint Arthroplasty in a Veteran Population

Stiegel, Kelly R.; Valentine, Matthew T.; Lash, Jonathan G.; Cardenas, Justin M.; Harrington, Melvyn A.; Green, David M.

doi:10.1016/j.arth.2020.12.010

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Reduction in LOS after joint arthroplasty surgery has demonstrated a direct correlation with reduction in postoperative complications and healthcare expenditure, 13,14 which in turn led to the development of early discharge protocols and same-day discharge utilization in the private sector. 15,16 A study by Kiskaddon et al, also of a VA, demonstrated that in carefully selected patients, an early discharge program was successful within the VA (albeit not with the extent of results and LOS reduction found in this study).…”

Section: Discussionmentioning

confidence: 99%

“…Management of patients in the VA healthcare system is associated with a distinct set of challenges because of the medical complexity of patients and barriers secondary to the healthcare system. 6,13,18,19 Frisch et al 18 previously demonstrated that the VA population had markedly higher rates of medical comorbidities, readmissions, prolonged LOS > 4 days, and complications within 30 days after TJA compared with the general population. We saw similar results before the initiation of our CJP, with LOS and complications far exceeding the national average.…”

Section: Discussionmentioning

confidence: 99%

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Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital

Kolade,

Nowell,

Mahoney

et al. 2023

J Am Acad Orthop Surg

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Introduction: Early discharge protocols have become a major surgical paradigm, but this protocol is not routinely used in the Veteran Affairs (VA) system. The primary objective was to demonstrate the feasibility of a comprehensive joint program (CJP) protocol, including same-day discharge, at a VA hospital. Secondary objectives are to determine whether an increase in postoperative complications, increased readmissions, and increased ER visits compared with previous management protocols occur. Methods: A retrospective review of patients undergoing primary total joint arthroplasty conducted before the initiation of CJP was compared with patients undergoing primary total joint arthroplasty conducted after the initiation of CJP. The two cohorts were subdivided further into total knee arthroplasty (TKA) and total hip arthroplasty (THA). Patients' demographics, medical comorbidities, discharge disposition, length of stay (LOS), surgery information, 30-day and 90-day postoperative complications, surgical site infections, and emergency room visits were collected and assessed with paired t-tests. Results: A total of 200 control cases (101 TKA, 99 THA) were compared with 260 cases (165 TKA, 95 THA) in the CJP group. The mean LOS reduced from 4.38 days in the control group to 0.75 days in the CJP group (P < 0.001), with 890 total inpatient days in the control group compared with just 200 total inpatient days with the CJP group. A total of 92 patients (34.5%) in the CJP group were discharged the same day compared with 0 in the control group (P < 0.001). In the control group, 47.8% were discharged to rehabilitation centers compared with only 4.5% in the CJP group (P < 0.001). The 30-day complication rate was reduced with CJP (5.6% vs. 10.3% control) (P = 0.028). ER visits did not significantly change (8.9% control vs. 9.3% CJP; P = 0.77). Conclusion: Overall LOS and complication rates were reduced with the CJP, exemplifying the viability of such a protocol in the VA system. In addition, we demonstrated no increased risks accompanied with early discharge to home. This initiative can be used to reduce healthcare dollars in VA healthcare system nationally.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital

Kolade,

Nowell,

Mahoney

et al. 2023

J Am Acad Orthop Surg

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“…One possible explanation could be that patients destined for non-home discharge (such as rehabilitation) would be able to leave the hospital sooner and therefore have decreased length of stay in the CI group. 40 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

Krishnan

Brovman

Urman

2021

Geriatr Orthop Surg Rehabil

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Background: The study assessed whether pre-existing cognitive impairment (CI) prior to elective total knee arthroplasty (TKA) is associated with worse postoperative outcomes such as delirium, in-hospital medical complications, 30-day mortality, hospital length of stay and non-home discharge. Methods: A retrospective database analysis from the NSQIP Geriatric Surgery Pilot Project was used. There was an initial cohort of 6350 patients undergoing elective TKA, 104 patients with CI were propensity score matched to 104 patients without CI. Results: Analysis demonstrated a significantly increased incidence of post-operative delirium (POD) in the cohort with pre-op CI (p = < .001), a worsened functional status (p = < .001) and increased nonhome discharge postoperatively compared to the group without CI (p = 0.029). Other post-operative outcomes included 30-day mortality of 0% in both groups, and low rate of complications such as infection (2.88% vs 0.96%), pneumonia (1.92% vs 0%), failure to wean (0.96% vs 0%), and reintubation (0.96% vs 0%). Some other differences between the CI group and non-CI group, although not statistically significant, included increased rate of transfusion (10.58% vs 6.73%), and sepsis (1.92% vs 0%). The length of stay was increased in the non-CI group (4.28% vs 2.32%, p = 0.122). Conclusion: CI in patients undergoing TKA is associated with an increased risk of POD, worsened postoperative functional status, and discharge to non-home facility.

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Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty

Lakra

Tram

Bernasek

et al. 2023

The Journal of Arthroplasty

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Early and Direct Rehab Transfer Leads to Significant Cost Savings and Decreased Hospital Length of Stay for Total Joint Arthroplasty in a Veteran Population

Cited by 6 publications

References 21 publications

Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital

Initiation of a Comprehensive Early Discharge Program at a Veterans Affairs Hospital

Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty

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