Surgical Scheduling Impacts Hospital Length of Stay and Associated Healthcare Costs for Patients Undergoing Total Hip and Knee Arthroplasty

2021 ◽  
pp. 155633162110400
Author(s):  
Sofia Ahsanuddin ◽  
Daniel J. Snyder ◽  
Hsin-Hui Huang ◽  
Aakash Keswani ◽  
Jashvant Poeran ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Skilled Nursing ◽  
Total Hip ◽  
Surgical Scheduling ◽  
Modifiable Factor ◽  
Day Of The Week

Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.

scholarly journals Improving Orthopedic Care Delivery Through Digital Engagement

Iproceedings ◽  
10.2196/16305 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16305
Author(s):  
Lisa Biernat ◽  
Carly E Milliren ◽  
Jon Rauen ◽  
Bill Lindsay ◽  
Betsy Weaver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hip Replacement ◽  
Skilled Nursing Facility ◽  
Patient Activation ◽  
Hospital Length Of Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Total Knee ◽  
Ed Visits

Background Patient activation has been hypothesized to improve medical and surgical outcomes by increasing patient involvement in the care plan. We tested this hypothesis by utilizing a patient activation tool in a population of adults having total hip or total knee replacement. We hypothesized that patient activation would be associated with increased discharge to home as opposed to a skilled nursing facility, reduced hospital length of stay, decreased inpatient readmissions, and decreased emergency department (ED) visits. Objective Using an email patient activation tool, we sought to increase patients’ involvement in their care before and after total joint replacement. Outcomes examined included day of surgery cancellation, length of hospital stay, discharge to home vs discharge to a skilled nursing facility, any ED visit within 30 days of discharge, and any inpatient readmission within 30 days of discharge Methods This was a quasi-experimental design comparing Jan-Jun 2017 to Jan-Jun 2018. We instituted an email patient activation tool for all patients with total knee or total hip replacement surgery beginning in January 2018. This tool was integrated with the electronic medical record system during the six month study period and patients could opt out at anytime if they desired. The tool was designed to prepare patients both educationally and emotionally for their operation with multiple easy-to-read emails starting from the time they were scheduled for surgery through six months postop. Percent of emails opened and clicked were used as measures of engagement for the intervention participants. Results Of the 2,027 TJR patients included, 720 were hip patients and 1,307 were knee patients. Pre- and postintervention groups were similar in gender and age. For hip replacement patients, length of stay was nearly 1/4 day lower in the postintervention group (β=-0.23; P=.001) after adjusting for gender, age and insurance; ED visits were lower among the postintervention group (OR=0.45; P=.05) after adjusting for gender, age and insurance; and postintervention patients were less likely to have day of surgery cancellation, any revisit (ED or readmission), and were more likely to be discharged home. However, these associations did not reach statistical significance. Conclusions Among patients who received the intervention, higher engagement was significantly associated with positive changes in almost all outcomes. Use of the digital patient activation tool demonstrated significant savings in length of stay and reduced ED visits among hip replacement patients. Although just under 50% of patients in the intervention group were enrolled to use the tool, these findings were still significant even when non-participants were included in the postintervention group.

Delirium occurrence and association with outcomes in hospitalized COVID-19 patients

2021 ◽  
pp. 1-5
Author(s):  
Sandeep Pagali ◽  
Sunyang Fu ◽  
Heidi Lindroth ◽  
Sunghwan Sohn ◽  
M. Caroline Burton ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Mayo Clinic ◽  
Skilled Nursing Facility ◽  
Age Groups ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Chi Square ◽  
Skilled Nursing ◽  
Mortality And Morbidity ◽  
Chi Square Test

ABSTRACT Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals. A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group. A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27–5.83) for in-hospital mortality and an OR 4.54 (3.25–6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.

scholarly journals Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty

2020 ◽  
Author(s):  
Ryan D'Souza ◽  
Christopher Duncan ◽  
Daniel Whiting ◽  
Michael Brown ◽  
Matthew Warner ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Hospital Cost ◽  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Knee

Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p<0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p=0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient -0.582, 95% CI -1.008– -0.156, p=0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p=0.023) and reduced total hospital cost of care by 6.45% (p<0.001), room and board costs by 11.76% (p<0.001), and transfusion costs by 81.65% (p<0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.

Influence of Insurance Status on Hospital Length of Stay and Discharge Location in Burn Patients

2018 ◽  
Vol 84 (6) ◽  
pp. 924-929 ◽  
Author(s):  
Rachel M. Nygaard ◽  
Jon R. Gayken ◽  
Frederick W. Endorf
Keyword(s):  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Insurance Status ◽  
Burn Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Lengths Of Stay ◽  
Discharge Location

Insurance status affects many aspects of healthcare in America, from access to delivery to outcomes. Our goal in this study was to determine whether different subtypes of insurance status affected hospital lengths of stay (LOS) and/or the location to which patients were discharged. The National Burn Repository was used to examine a total of 119,509 burn patients. Patients with noncommercial insurance (NONCOM) have increased LOS and are more likely to be discharged to a nonhome location, compared with no insurance or other insurance subtypes. Patients with no insurance have similar injury characteristics and comorbidities as patients with NONCOM, but have a shorter LOS and are more likely to be discharged home rather than to a skilled nursing facility or rehabilitation facility.

Day of Surgery and Surgical Start Time Affect Hospital Length of Stay After Total Hip Arthroplasty

2016 ◽  
Vol 31 (11) ◽  
pp. 2426-2431 ◽  
Author(s):  
Aakash Keswani ◽  
Christina Beck ◽  
Kristen M. Meier ◽  
Adam Fields ◽  
Michael J. Bronson ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Start Time ◽  
Total Hip

Could payer mix affect length of stay or readmissions among an outpatient palliative care cohort?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 165-165
Author(s):  
Ali John Zarrabi ◽  
Karen Armstrong ◽  
Kimberly A. Curseen ◽  
Tammie E. Quest
Keyword(s):  
Palliative Care ◽  
Length Of Stay ◽  
Hospital Readmissions ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Commercial Insurance ◽  
Discharge Disposition

165 Background: Outpatient palliative care clinics (PCC) are a developing frontier of palliative medicine. Characterizing and promoting financially viable models for payment of services are imperative to the sustainability of PCC. There is a paucity of research addressing payer mix – meaning the breakdown of individuals and organizations that pay for a provider's services – in PCC or its impact on metrics important to quality in PC such as hospital length of stay (LOS) and hospital readmissions. We seek to describe the payer mix for our academic outpatient PC practice. Furthermore, we sought to identify if payer mix (commercial, government—Medicare, Medicaid – or self-pay) influenced hospital LOS, discharge to hospice, or readmissions. Methods: After obtaining IRB approval, we conducted a retrospective chart review of supportive oncology patients from 2014-2017 (n = 3137) using data restricted to ICD10 codes for solid tumors. We performed bivariate tests and multivariable logistic regressions to examine the main effects of length of stay (LOS), readmissions, insurance status, and discharge disposition using SAS version 9.4 (Cary, NC). Results: Payer mix included 711 (24%) commercial insurance enrollees, 2357 (75%) Medicare or Medicaid recipients, and 38 (1%) self-pay. Mean LOS was 12.7 days (SD 16.38). The majority (94%) of patients had more than 5 readmissions. Commercial insurance was associated with prolonged LOS ( > = 30 days), discharge disposition to hospice, and hospital readmissions ( > 5) compared to government insurance (p < 0.05). Of the 3137 patients, 325 (10%) expired, 1328 (42%) were discharged to hospice, while 1463 (47%) were discharged to rehab, skilled nursing facilities or home care. Conclusions: The majority of patients in our academic PCC had governmental insurance and were less likely than those with commercial insurance to have prolonged LOS, discharge to hospice, or hospital readmission. These findings provide evidence that further investigation is needed to examine the effect of payer mix on PCC and patient outcomes.

scholarly journals Safety and Costs of Stroke Unit Admission for Select Acute Intracerebral Hemorrhage Patients

2017 ◽  
Vol 8 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Corey R. Fehnel ◽  
Kimberly M. Glerum ◽  
Linda C. Wendell ◽  
N. Stevenson Potter ◽  
Brian Silver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Stroke Unit ◽  
Skilled Nursing Facility ◽  
Patient Characteristics ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Disposition ◽  
Group 5

Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment. The primary outcome was poor functional status at discharge (modified Rankin score [mRS] ≥3). Secondary outcomes included complications, discharge disposition, hospital length of stay, and direct inpatient costs. Results: The study population included 104 patients (41 admitted to the ICU and 63 admitted to the SU). After controlling for differences in baseline characteristics, there were no differences in poor functional outcome at discharge (93% vs 85%, P = .26) or in mean mRS (2.9 vs 3.0, P = .73). Similarly, there were no differences in the rates of complications (6% vs 10%, P = .44), discharged dead or to a skilled nursing facility (8% vs 13%, P = .59), or direct patient costs (US$7100 vs US$6200, P = .33). Median length of stay was significantly longer in the ICU group (5 vs 4 days, P = .01). Conclusions: This study revealed a shorter length of stay but no large differences in functional outcome, safety, or cost among patients with minor ICH admitted to a dedicated SU compared to an ICU.

Abstract P387: Length of Stay Among Medicare Beneficiaries Hospitalized with Heart Failure

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Emily B Levitan ◽  
Melissa K Van Dyke ◽  
Ligong Chen ◽  
Meredith L Kilgore ◽  
Todd M Brown ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Systolic Dysfunction ◽  
Skilled Nursing Facility ◽  
The United States ◽  
Demographic Characteristics ◽  
Hospital Length Of Stay ◽  
Medicare Beneficiaries ◽  
Nursing Facility ◽  
Skilled Nursing

Background: Heart failure (HF) is among the most common reasons for hospitalization in the United States. Hospital length of stay (LOS) is a driver of cost and disease burden. Objectives: To examine factors associated with LOS of HF hospitalizations. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims with ≥1 overnight stay/2 hospital days with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. The median and interquartile range (IQR) LOS was calculated by demographic characteristics, comorbidities, and discharge status based on Medicare claims data with the Kruskal-Wallis test to compare distributions in the overall population with HF (n = 45,584) and in the subpopulation with documented systolic dysfunction (n = 10,256). Results: The median LOS was 5 days (range 2-255, IQR 4-8 days) in the overall HF population and 5 days (range 2-204, IQR 4-8 days) in those with systolic dysfunction. Across most demographic characteristics and comorbidities, the median LOS was 5 days but was higher among nursing home residents and individuals with malnutrition in both groups and with chronic kidney disease in those with systolic dysfunction ( Figure ). All comorbidities were associated with a shift in the distribution toward longer LOS in the population with systolic dysfunction and all but coronary heart disease in the overall population (p < 0.001). HF patients discharged to a skilled nursing facility had longer LOS (median 7 days, IQR 5-10 days) versus other discharge statuses (median 5 days, IQR 3-7 days, p < 0.001) in both populations. Conclusions: In patients hospitalized for HF, the median LOS was 5 days across most comorbidities and other characteristics, but comorbidities were associated with a shift in the upper tail of the distribution toward longer LOS. Worse functional status (nursing residence or discharge to a skilled nursing facility) was associated with a higher median LOS.

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