A new study, presented at the American Academy of Orthopaedic Surgeons Annual Meeting 2015, examined length of stay for primary total hip and knee arthroplasty procedures, as it is a significant cause of cost variation among healthcare providers. Researchers found that primary THA and TKA done late in the week, as opposed to earlier in the week, led to increased length of stay.
Researchers reviewed an administrative clinical database at a large U.S. healthcare system and identified all primary THA and TKA admissions. After exclusion criteria, 14,800 cases were considered for analysis.
According to the study, there was a significant increase in mean length of stay based on day of surgery — from 3.48 days for Monday procedures to 3.89 days for Thursday and 3.93 for Friday. Late week admissions were associated with 0.358 additional days when compared to early week admissions.
Here, Trevor G. Murray, MD, an orthopedic surgeon at Cleveland Clinic and lead author of the study, discusses the results of the research and its potential influence.
Question: Were the results of this study unexpected?
TM: We had the sense that primary hip and knee arthroplasty patients tended to stay longer and that was the impetus for the study. When we analyzed the data in the administrative database, we found that patients undergoing hip and knee replacement procedures on Monday and Tuesday didn't stay as long as those undergoing procedures on Thursday or Friday. We found that getting operated on later in the week is an independent risk factor for increased length of stay and increased charges and then extrapolated that increased LOS will lead to increased cost.
Question: How do you think these results will impact patient care in orthopedics?
TM: It may impact patient care in a couple of ways. Every patient is impacted by the overall cost of healthcare, especially now with the advent of value-based payments. Therefore patients and providers need to more financially responsible the care that is provided. Also, this study shows that there may be a need to ensure that patients undergoing hip and knee replacements either have them done early in the week or, if late in the week, make sure there are appropriate resources allocated to them so that their LOS is not increased.
Another important impact is that patients, who will be more involved in evaluating where they have their procedures done, understand the factors that influence reported quality measures and are able to accurately compare them with between facilities.
Question: Why are these study results important for the orthopedic industry in today's rather uncertain healthcare climate?
TM: In the short term, organizations that are already providing care based on value should look critically at their discharge capabilities and make sure the discharge process is being performed appropriately. Additionally, many patients will soon be in bundled payment programs. Certainly for those that are, it makes sense to schedule their procedures earlier in the week.
Question: What are the next steps for research in this area?
TM: From our standpoint, we feel very confident in the validity of the findings. Our next steps will be to perform hip and knee replacements on patients in a bundled payment program early in the week. We are also looking to better understand the obstacles encountered for discharge of patients operated on late in the week and working to standardize a discharge process to mitigate those impediments to discharge. The final step is to then evaluate the program to see if it has solved the problem.