The length of stay and readmissions of THA and TKA patients: A longitudinal analysis using a nationwide readmissions data

ABSTRACT

Aim:

Analyze readmission trends of Total Hip Arthroplasty (THA)/Total Knee Arthroplasty (TKA) patients and examine the impact of LOS on the likelihood of hospital readmission, with an emphasis on discharge disposition and patients underlying conditions.

Background:

Demand and cost of THA/TKA have increased over the years. However, length of stay (LOS) has decreased due to fewer after-surgery complications and advances in pain management. Overall, healthcare cost is on an upward trajectory, and the cost of unplanned readmissions constitutes a large portion of it, so it is vital to examine the relationship between LOS and unplanned readmissions.

Methods and Results:

We use a linear probability model. LOS decreased steadily during the sampled period. Readmitted patients were more likely to be under Medicare/Medicaid and had more significant medical comorbidities. Readmission increases with LOS, but patients with fewer comorbidities are less likely to be readmitted. Patients discharged under ‘routine’ disposition were less likely to be readmitted, while those discharged against medical advice were more likely to be readmitted.

Conclusion:

LOS impacts THA/TKA readmission rates; however, patient characteristics such as medical comorbidity and discharge disposition are essential in determining the readmission status and, therefore, necessary inputs in the decision-making processes.

KEYWORDS:

• Total hip arthroplasty
• total knee arthroplasty
• length of stay
• readmission
• discharge disposition

Acknowledgments

None

Disclosure statement

No potential conflict of interest was reported by the author(s).

Contributors

None.

Conflicts of interest

There are no conflicts of interest.

Ethics approval

None

Additional information

Funding

No external funding was received.

Notes on contributors

Steve Muchiri

Steve Muchiri, MBA, PhD, is a tenured Associate Professor of Economics and the coordinator of Labor and Human Resources Major (LHR) at Eastern Connecticut State University (ECSU). For the last 5 years, he has also served on the Honors Council for the ECSU's Honors program. Dr. Muchiri has extensive experience in teaching statistics for both Economics and non-Economics majors. He has also taught Econometrics, senior-level Health and Labor Economics, and senior seminar courses.

Fatma Pakdil

Fatma Pakdil, MBA, PhD, is a tenured Professor of Management at Eastern Connecticut State University (ECSU). She holds her BS in econometrics and PhD in Management and Organization. She has been working on quality management, lean management, Six Sigma, business analytics, and healthcare management research in academia since 2000. Dr. Pakdil is an internationally recognized scholar on lean management, quality management, and healthcare management topics.

Hannah Beazoglou

Hannah Beazoglou is an associate in CVS Health's General Management Development Program. Her current placement is with Network Strategy and Provider Experience at Aetna, a CVS Health company. She received a Bachelor of Science degree in Business Administration from Eastern Connecticut State University.