Early Discharge After Total Hip Arthroplasty at an Urban Tertiary Care Safety Net Hospital: A 2-Year Retrospective Cohort Study
| Autor: | Grant S Shewmaker, Eric L. Smith, Max Vaickus, Maxwell C Alley, David M. Freccero, Ruijia Niu |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Arthroplasty Replacement Hip medicine.medical_treatment Logistic regression Patient Readmission Postoperative Complications Risk Factors medicine Humans Orthopedics and Sports Medicine Early discharge Retrospective Studies Univariate analysis Tertiary Healthcare business.industry Medical record Retrospective cohort study Perioperative Emergency department Length of Stay Middle Aged Arthroplasty Patient Discharge United States Emergency medicine Surgery business Safety-net Providers |
| Zdroj: | Journal of the American Academy of Orthopaedic Surgeons. 29:894-899 |
| ISSN: | 1940-5480 1067-151X |
| Popis: | Introduction Previous studies have shown that shorter inpatient stays after total hip arthroplasty (THA) are safe and effective for select patient populations with limited medical comorbidity and perioperative risk. The purpose of our study was to compare the postoperative complications because they relate to the length of hospital stay at a safety net hospital in the urban area of the United States. Methods We retrospectively reviewed the medical records of 236 patients who underwent primary THA in 2017 at an urban safety net hospital. We collected data on demographics, medical comorbidities, and surgical admission information. Patients were categorized as "early discharge" if they were discharged on postoperative day 0 to 1 and "standard discharge" if they were discharged on postoperative day 2 to 5. The outcomes of interest were 90-day and 2-year postoperative complications, emergency department visit, readmissions, and revision surgeries. Data were analyzed using t-test or chi-square test for univariate analysis and linear logistic regression for controlled analysis. Results Compared with the standard discharge group, there were markedly more male patients in the early discharge group (44.5% versus 80%). Early discharge patients were markedly younger (53.3 versus 59.5 years old), more likely to be White/non-Hispanic (64.4% versus 42.4%) and less likely to have heart disease and diabetes (2.2% versus 15.2% and 2.2% versus 19.9%, respectively). With adjustment for these potential confounders, no notable difference was observed in all-type complications, emergency department visits, readmission, or revision surgery between the two groups. Discussion This study confirmed that early discharge after THA is as safe as standard discharge in a safety net hospital with appropriate preoperative risk screening. Increased perioperative counseling and optimization of social and medical risk factors mitigated possible risk factors for increased length of stay and surgical complication. |
| Databáze: | OpenAIRE |
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