Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List

IF 1.5 Q3 ORTHOPEDICS

Arthroplasty Today Pub Date : 2024-11-18 DOI:10.1016/j.artd.2024.101568

Joshua G. Sanchez BA, Meera M. Dhodapkar MD, Scott J. Halperin MD, Will M. Jiang BS, Jonathan N. Grauer MD, Lee E. Rubin MD

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引用次数: 0

Abstract

Background

Total hip arthroplasty (THA) was removed from the Centers for Medicare and Medicaid Services inpatient-only (IPO) list on January 1, 2020. The impact of this policy changes on length of stay (LOS) and coding status (inpatient/outpatient) beyond 2020 remains to be fully defined.

Methods

Data were obtained from the 2018 to 2021 National Surgical Quality Improvement Program database. Elective primary THA patients aged 18 y or older were identified by Current Procedural Terminology code. Year of surgery, age (dichotomized at

\geq

/<65 y old), American Society of Anesthesiologists classification, smoking status, coding status, and LOS were assessed. Pearson chi-squared tests compared categorical variables, while analysis of variance tests evaluated continuous variables.

Results

Overall, 156,212 THA patients were identified. Over the 4 y of study, outpatient cases increased by 1392% from 3.7%-5.75% to 35.6%-54.2% (P < .0001). Analogously, average LOS decreased from 1.91-1.75 to 1.50-1.35 d (P < .0001). This pattern of decreased LOS was seen in patients aged ≥65 y (traditional Medicare eligibility, P < .0001) and those <65.

Conclusions

These data demonstrate a continued increase in outpatient THA since the IPO list removal, with over half of cases classified as outpatient in 2021 and a corresponding reduction in LOS. Notably, the outpatient status is an administrative designation that was not defined by same-day discharge or lack of overnight stay. The observed changes in both age groups (≥65 and <65 y) underscore the extensive impact of the IPO list removal on surgical practices.

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2018 年至 2021 年全髋关节置换术住院时间和编码状态趋势：从住院病人专用名单中删除的两年期影响

背景全髋关节置换术（THA）于 2020 年 1 月 1 日从美国医疗保险和医疗补助服务中心住院患者（IPO）名单中删除。这一政策变化对 2020 年以后的住院时间（LOS）和编码状态（住院病人/门诊病人）的影响仍有待全面界定。方法数据来自 2018 年至 2021 年国家外科质量改进计划数据库。根据当前程序术语代码确定了年龄在 18 岁或以上的选择性初级 THA 患者。对手术年份、年龄（≥/<65 岁二分法）、美国麻醉医师协会分类、吸烟状况、编码状况和 LOS 进行了评估。皮尔逊卡方检验比较了分类变量，而方差分析检验则评估了连续变量。在 4 年的研究中，门诊病例增加了 1392%，从 3.7%-5.75% 增加到 35.6%-54.2%（P < .0001）。同样，平均住院日也从 1.91-1.75 天降至 1.50-1.35 天（P < .0001）。这些数据表明，自 IPO 名单取消以来，门诊 THA 持续增加，2021 年超过一半的病例被归类为门诊病人，LOS 也相应减少。值得注意的是，门诊病人身份是一种行政指定，并不是根据当天出院或不过夜来定义的。在两个年龄组（≥65 岁和 <65 岁）观察到的变化凸显了取消《首次公开手术清单》对手术实践的广泛影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arthroplasty Today Medicine-Surgery

CiteScore

2.90

自引率

0.00%

发文量

258

审稿时长

40 weeks

期刊介绍： Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.