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

Abstract

AbstractIn 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.