Reducing Length of Stay Does Not Increase Emergency Room Visits or Readmissions in Patients Undergoing Primary Hip and Knee Arthroplasties

Background: Total hip and total knee arthroplasty (total joint arthroplasty [TJA]) are 2 of the most common elective surgeries. Identifying which patients are at highest risk for emergency room (ER) visits or readmissions within 90 days of surgery and the reasons for return are crucial to formulate ways to decrease these visits and improve patient outcomes. Methods: This is a retrospective review of a consecutive series of 7466 unilateral primary TJA performed from July 2013 to June 2017; any patients who had an ER visit or readmission in the first 90 days after surgery were identified, and a detailed chart review was performed. Patients discharged home or to rehab were analyzed separately. Results: Three hundred thirty-six (4.5%) patients had 380 ER visits and 250 (3.3%) patients had 291 readmissions in the first 90 days after TJA. Patients returning to the ER were equivalent to those who did not. Patients who went to a rehab facility on discharge were significantly more likely to be readmitted (P = .000). Patients who were readmitted had a higher American Society of Anesthesiologists score (P = .000). Length of stay decreased over the study period from 2.66 days to 1.63 days, while the number of unplanned interventions remained steady. Pain and swelling was the most common reason for return for ER visits (33.2%) and readmissions (14.1%). Conclusion: The overall number of unplanned interventions after TJA in this population was low and remained consistent over time despite decreasing length of stay. Patients who went to rehab were more likely to experience readmission. The majority of unplanned interventions occurred in the first 4 weeks after surgery. (C) 2018 Elsevier Inc. All rights reserved.