Optimal Length of Stay Following Total Joint Arthroplasty to Reduce Readmission Rates.

BACKGROUND: Length of stay (LOS) following total joint arthroplasty (TJA) continues to decrease. The effects of this trend on readmission risk and total cost are unclear. We hypothesize that optimal LOS following TJA minimizes index hospitalization, early readmission risk, and total cost. METHODS: Retrospective data from the South Carolina Department of Revenue and Fiscal Affairs was reviewed for patients who underwent primary TJA in South Carolina from 2000 to 2015 (n = 172,760). Data for readmissions within 90 days were included. Severity of illness was estimated by Elixhauser score (EH). Index LOS is defined as the surgery and the subsequent hospital stay. RESULTS: Patients with more significant medical comorbidities (EH ≥ 4) had significantly longer LOS than healthier patients (4.0 vs 3.4 days, P < .001). Independent of EH, readmitted patients had a significantly longer index LOS than those never readmitted (4.3 vs 3.6 days, P < .001). For healthier patients (EH ≤ 3), each additional inpatient day increased readmission risk, while among sicker patients, staying 2 days vs 1 day was protective against readmission risk. Since 2000, the total index cost of TJA has doubled and average cost per inpatient day has tripled, but readmission rates remain essentially unchanged (7.4% to 7.0%). CONCLUSION: Increased LOS was associated with increased readmission risk. Patients with greater medical comorbidities stay longer to protect against readmission. Optimal LOS after TJA is highly influenced by the patient's overall health. Despite a 300% increase in TJA daily cost, readmission rate has changed minimally over the last 15 years.

Fewer Complications Following Revision Hip and Knee Arthroplasty in Patients With Normal Vitamin D Levels.

BACKGROUND: Surgeons and hospitals increasingly face penalty for complications and readmission following total joint arthroplasty; therefore, optimization of modifiable risk factors is paramount. Literature associates low vitamin D with risk of periprosthetic joint infection, and we hypothesized low vitamin D to be predictive of increased rate of complications and readmissions. METHODS: A retrospective review of 126 revision total joint arthroplasty patients between 2010 and 2014 was performed. RESULTS: Low vitamin D was not associated with risk of 30-day readmission but was found to be associated with an increased risk of 90-day complications as well as periprosthetic joint infection as the reason for revision surgery. CONCLUSION: Preoperative vitamin D level should be considered a modifiable risk factor for complications following revision arthroplasty.