The Association Between Hospital Length of Stay and 90-Day Readmission Risk Within a Total Joint Arthroplasty Bundled Payment Initiative

Mortality, readmission and length of stay have different relationships using hospital-level versus patient-level data: an example of the ecological fallacy affecting hospital performance indicators

“…On the other hand, Bottle et al 9 found that the relation between LOS and readmission was J-shaped, with same-day discharges having a high readmission rate. Williams et al 11 and Clement et al 12 found that hip and/or knee arthroplasty patients with an increased LOS had an increased risk for readmission, consistent with our patient-level results. However, other studies suggested that a decreased LOS over time was not associated with a change in readmissions,13 14 but this was based on aggregated data comparing a decrease over time for LOS with relatively stable readmission rates over the same period.…”

“…In addition there is a trend towards fast-track surgery for specific diagnoses, for example, decreasing LOS after total hip or knee arthroplasty. Williams et al 11 and Clement et al 12 found that patients with a hip/knee arthroplasty and an increased LOS had an increased risk for readmission, but other studies showed that a decreased LOS over time was not associated with a change in readmissions 13 14. Results from previous studies are thus inconsistent.…”

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

“…These include surgeon volume, operative time, general anesthesia, use of anticoagulation other than aspirin, increased length of hospital stay, and discharge to an inpatient rehabilitation facility [43][44][45][46][47]. Kurtz et al [44] found that increased surgeon volume has a protective effect against readmissions after TJA.…”

“…This may be partially due to the fact that increased hospital length of stay can increase the risk of hospital-acquired infections and thromboembolic events. Lastly, multiple studies have shown that discharge to inpatient facilities is associated with worse outcomes and increased rates of readmission [43][44][45][46][47]. A study by Fu et al [47] showed that discharge to inpatient facilities is independently associated with a higher rate of readmission and increased risk for a number of postdischarge complications.…”

“…Increased length of stay has been shown to have a large impact on the risk of readmission after TJA. In a study by Williams et al [46], hospital length of stay of greater than 4 days was found to nearly double the chance of readmission. This may be partially due to the fact that increased hospital length of stay can increase the risk of hospital-acquired infections and thromboembolic events.…”