Arguelles, William

Hernandez, Yvette

Parris, Don

Rivera, Priscilla

Suarez, Juan Carlos

English

Scholarly Commons@Baptist Health South Florida

Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 11-2019 Preoperative Factors Related to Delayed Discharge after Total Knee Arthroplasty Removal from Inpatient-Only List Juan Carlos Suarez Baptist Health Medical Group; Miami Orthopedics & Sports Medicine Institute, juansu@baptisthealth.net William Arguelles Baptist Health South Florida, williamar@baptisthealth.net Priscilla Rivera Baptist Health South Florida, PriscillRi@baptisthealth.net Yvette Hernandez Baptist Health South Florida, yvettesal@baptisthealth.net Don Parris Baptist Health South Florida, donp@baptisthealth.net Follow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publications  Part of the Orthopedics Commons Citation Suarez, Juan Carlos; Arguelles, William; Rivera, Priscilla; Hernandez, Yvette; and Parris, Don, "Preoperative Factors Related to Delayed Discharge after Total Knee Arthroplasty Removal from Inpatient-Only List" (2019). All Publications. 3332. https://scholarlycommons.baptisthealth.net/se-all-publications/3332 This Conference Poster -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has been accepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For more information, please contact Carrief@baptisthealth.net. • The Centers for Medicare & Medicaid Services removed total knee arthroplasty (TKA) from the inpatient-only (IPO) list effective January of 2018• Consequently, all TKAs were scheduled as outpatient (23-hour observation) without workflow modifications• While previous studies have identified specific factors associated with successful outpatient TKAs, none have been described under these mandatory, non-selective circumstances1-5• Specific aim: to examine the preoperative factors associated with delayed discharge following this policy change among a non-selected cohort, as published data in this area are lackingPreoperative Factors Related to Delayed Discharge after Total Knee Arthroplasty Removal from Inpatient-Only ListJuan C. Suarez, MD,1 William Arguelles, PhD, MSPH,2 Priscilla Rivera, MPH, 2 Yvette Hernandez,3 & Don Parris, PhD, 21 Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida; 2 Center for Advanced Analytics, Baptist Health South Florida; 3 Center for Research, Baptist Health South FloridaBackground Results ConclusionsAcknowledgements• 447 TKA patients were identified during the study period• 279 (62.4%) had a non-delayed discharge• 168 (37.6%) had a delayed discharge• The following table presents the association between preoperative factors and delayed discharge among TKA patients originally scheduled as outpatient following TKA removal from IPO list• Almost 40% of our population had a ≥ 2 night hospital stay despite being scheduled as outpatient• Preoperative factors associated with delayed discharge included older age, female sex, hypertension, and COPD• With the numbers of available for study, delayed discharge was not related to race/ethnicity, insurance type, preoperative education, anesthesia type, smoking, body mass index, diabetes, cardiovascular disease, or kidney disease• The influence of social support warrants further investigation since discharge to an institution was prevalent in the delayed group• Limitations:• Small sample size, with limited prevalence of certain conditions• Missing data on preoperative education class attendance • We’d like to thank Beth Willmitch, Zenia Reyes-Bardelas, Alicia d’Empaire, and their Information Technology teams for their data supportMain Findings:• Delayed discharge was related to: • Older age• Female sex• Hypertension• COPD• Post-hoc analyses revealed that patients with delayed discharge were more likely to be discharged to an institution (26.8% vs. 5.8%, p <0.001) than home (73.2% vs. 94.2%, p <0.001), suggesting social support may also play an important roleMethods• TKA patients admitted to any Baptist Health South Florida facility between January 01, 2018 and August 01, 2018 were retrospectively analyzed• Patients were stratified into two groups based on hospital night stay:• ≤ 1 night (non-delayed discharge)• > 1 night (delayed discharge)• The association between the following preoperative factors and delayed discharge were examined using 2-tailed t-tests for continuous data, and Pearson’s chi-square or Fischer exact tests for categorical data• Age; gender; race/ethnicity; insurance type; preoperative education class attendance; anesthesia type; smoking; body mass index (BMI); diabetes; hypertension; cardiovascular diseases; chronic obstructive pulmonary disease (COPD); and kidney disease • All analyses were conducted using SPSS (IBM, version 23.0)Baptist HospitalReferences1. Arshi, A., Leong, N. L., D’Oro, A., Wang, C., Buser, Z., et al. (2017). Outpatient total knee arthroplasty is associated with higher risk of preoperative complications. The Journal of Bone and Joint Surgery, 99, 1978-1986.2. Courtney,P. M., Friomson, M. I., Michael Meneghini, R. M., Lee, G., Della Valle, C. J., (2018). Can total knee arthroplasty be performed safely as an outpatient in the medicare population? The Journal of Arthroplasty, 1-4.3. Gauthier-Kwan, O. Y., Dobranksy, J. S., Dervin, G.F., (2018). Quality of recovery, postdischarge hospital utilization, and 2-year functional outcomes after an outpatient total knee arthroplasty program. The Journal of Arthroplasty, 1-6.4. Hoffmann, J. D., Kusnezov, N. A., Dunn, J. C. Zarkadis, N. J., Goodman, G. P., et al. (2018). The shift to same-day outpatient joint arthroplasty: a systemic review. The Journal of Arthroplasty, 33, 1265-1274.5. Lovett-Carter, D., Sayeed, Z., Abaab, L., Pallekonda, V., Mihalko, W., et al. (2018). Impact of outpatient total joint replacement on postoperative replacement in postoperative outcomes. Ortthop Clin Am, 49, 35-44.VariableNights ≤ 1N = 279Nights > 1N = 168 P valueAge (years) 69.9 (8.6) 71.5 (8.0) 0.033GenderMale 124 (44.4%) 39 (23.2%) <0.001Female 155 (55.6%) 129 (76.8%)Race/ethnicityNon-Hispanic White 107 (38.4%) 53 (31.5%) 0.348Hispanic White 157 (56.3%) 105 (62.5%)Other or unknown 15 (5.4%) 10 (6.0%)Insurance type 0.185Medicare HMO 97 (34.8%) 75 (44.6%)Medicare HCFA 107 (38.4%) 62 (36.9%)HMO 41 (14.7%) 15 (8.9%)PPO 20 (7.2%) 9 (5.4%)Other 14 (5.0%) 7 (4.2%)Preoperative education 0.782Yes 61 (87.1%) 36 (83.7%)No 9 (12.9%) 7 (16.3%)Anesthesia type 0.111General 60 (21.5%) 46 (27.4%)Spinal 79 (28.3%) 55 (32.7%)Spinal with MAC 135 (48.4%) 62 (36.9%)Other 5 (1.8%) 5 (3.0%)Smoking 29 (10.4%) 23 (13.7%) 0.291BMI (kg/m2) 30.8 31.2 0.464Diabetes 33 (11.8%) 27 (16.1) 0.252Hypertension 109 (39.1%) 82 (48.8%) 0.049Cardiac disease 4 (1.4%) 3 (1.8%) 1.000CHF 1 (0.4%) 1 (0.6%) 1.000Stroke 2 (0.7%) 1 (0.6%) 1.000COPD 0 (0%) 4 (2.4%) 0.020Kidney disease (creatinine > 1.5) 2 (0.7%) 0 (0%)

Preoperative Factors Related to Delayed Discharge after Total Knee Arthroplasty Removal from Inpatient-Only List

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Preoperative Factors Related to Delayed Discharge after Total Knee Arthroplasty Removal from Inpatient-Only List

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