Complications, Mortality, and Costs for Outpatient and Short-Stay Total Knee Arthroplasty Patients in Comparison to Standard-Stay Patients

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Abstract

The purpose of the present study is to determine the differences in cost, complications, and mortality between knee arthroplasty (TKA) patients who stay the standard 3–4 nights in a hospital compared to patients who undergo an outpatient procedure, a shortened stay or an extended stay. TKA patients were identified in the Medicare 5% sample (1997–2009) and separated into the following groups: outpatient, 1–2 days, 3–4 days, or 5 + days inpatient. At two years, costs associated with the outpatient and the 1–2 day stay groups were $8527 and $1967 lower than the 3–4 day stay group, respectively. Out to 2 years, the outpatient and 1–2 day stay groups reported less pain and stiffness, respectively, though the 1–2 day group also had a higher risk for revision.

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Methodology

The Medicare 5% Limited Data Set (LDS) sample was used to identify patients with a total knee arthroplasty procedure between 1997 and 2009 using ICD-9-CM (81.54) and CPT4 (27447) codes. Patients were recruited continuously during the study period and followed until the end of the study period (December 31, 2009), until their benefits were terminated, or until death. Patients who received benefits for a reason other than age (i.e., end-stage renal disease or disability) and Medicare

Results

There were 71,341 3–4 day standard-stay patients, 23,134 5 + day, 7755 1–2 day, and 454 outpatient patients in the study cohort. Outpatient and 1–2 day stay patients tended to be younger and with a lower Charlson comorbidity score (Fig. 1, Fig. 2). Compared to the 3–4 day standard-stay group, the incremental payments for osteoarthritis attributable costs at 2 years were −$8527 (lower) for the outpatient group, −$1967 (lower) for the 1–2 day group, and +$1159 (higher) for the 5 + day group (Fig. 3).

Discussion

We estimated the costs, mortality and complications after TKA for differing lengths of stay in the U.S. Medicare population. Compared to standard-stay patients, there were sizeable cost reductions but an increased revision/readmission and mortality risk for the outpatient and short stay TKA groups. The shorter stay groups showed an improvement in associated diagnosed pain and stiffness compared to standard-stay patients, suggesting better early function. Patients who stayed, or were obliged to

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Study design, manuscript preparation, and review occurred at the offices of each author independently. The initial study design and data processing took place at Exponent, Inc., in Philadelphia, PA and Menlo Park, CA. All statistical analyses took place at Exponent, Inc., in Menlo Park, CA.

Support for this research was provided by Stryker.

The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.07.020.

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