Association between same day discharge total knee and total hip arthroplasty and risks of cardiac/pulmonary complications and readmission: a population-based observational study.
BMJ Open
; 9(12): e031260, 2019 12 08.
Article
em En
| MEDLINE
| ID: mdl-31818836
ABSTRACT
OBJECTIVE:
To determine if same-day discharge total knee arthroplasty (TKA) or total hip arthroplasty (THA) is not associated with increased risk of unplanned readmission and adverse outcomes within 30 days of surgery.DESIGN:
This is a population-based observational study.SETTING:
Patients from 708 participating institutions who underwent primary TKA or primary THA between 2011 and 2017 were divided into three groups by length of stay (LOS 0, 1 and 2-3 days). All patients with LOS>3 days were excluded from the current study. Regression analysis and propensity score matching were performed. DATA SOURCES American College of Surgeons-National Surgical Quality Improvement Programme database. MAIN OUTCOMES ANDMEASURES:
Primary outcomes included unplanned readmission and cardiac/pulmonary complications within 30 days of surgery.RESULTS:
We identified 226 481 TKA (LOS 0=3118, LOS 1=31 404, and LOS 2-3=1 91 959) and 140 557 THA patients (LOS 0=2652, LOS 1=29 617, and LOS 2-3=1 08 288). There were no differences in 30-day mortality. After adjusting for relevant covariates, LOS 0 (compared with LOS 1) was associated with higher odds of cardiac/pulmonary complications in both TKA (OR 1.95, 95% CI 1.20 to 3.16; 0.67% vs 0.37%) and THA (OR 1.96, 95% CI 1.05 to 3.64; 0.57% vs 0.26%). There were no statistical differences in unplanned readmissions between LOS 0 and LOS 1 groups in TKA (2.41% vs 2.31%) and THA (1.62% vs 2.04%).CONCLUSIONS:
LOS 0 discharge after TKA and THA was associated with higher odds of cardiac/pulmonary complications compared with LOS 1 discharge. While the overall burden of complications is relatively low, until future studies can confirm or challenge our findings, a measured approach is advisable when recommending discharge of patients on the same day of surgery.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Alta do Paciente
/
Readmissão do Paciente
/
Complicações Pós-Operatórias
/
Artroplastia de Quadril
/
Artroplastia do Joelho
/
Cardiopatias
/
Tempo de Internação
/
Pneumopatias
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
BMJ Open
Ano de publicação:
2019
Tipo de documento:
Article
País de afiliação:
Estados Unidos