Abstract
Background
Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA)
episode of care, and as a result, significant efforts are being made to minimize it.
This study aims to assess the utility of the Outpatient Arthroplasty Risk Assessment
(OARA) screening tool in accurately identifying patients for safe and early discharge
after THA.
Methods
A retrospective review was conducted on 332 consecutive patients who underwent primary
THA at a single tertiary academic center. Patients were evaluated using the OARA score,
a tool that has been proposed to identify patients who can safely undergo early discharge
after THA. The validity of these claims was assessed by analyzing the OARA score’s
positive and negative predictive values for high vs low OARA scores between patients
enrolled in our (1) same-day discharge (SDD) and 2) next-day discharge (NDD) pathways.
Results
When comparing the utility of the OARA score in accurately predicting length of stay,
the OARA score demonstrated a (1) higher, but constant, positive predictive value
for discharge on postoperative day (POD) 0 for SDD (86.1%) than POD1 for NDD (35.5%)
and (2) lower negative predictive value for discharge on POD0 (23.1%) for SDD than
POD1 for NDD (86.1%).
Conclusion
The OARA score was developed to risk-stratify patients who can safely undergo SDD
or NDD after THA. In this study, the OARA score was a highly predictive tool in identifying
NDD patients at risk for failure of discharge by POD1.
Keywords
Level of evidence
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of ArthroplastyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.J Bone Jt Surg. 2007; 89: 780-785https://doi.org/10.2106/JBJS.F.00222
- Gainsharing strategies, physician champions, getting physician buy.J Arthroplasty. 2017; 32: 1723-1727https://doi.org/10.1016/j.arth.2017.02.011
- Early results of Medicare’s Bundled Payment Initiative for a 90-day total joint arthroplasty episode of care.J Arthroplasty. 2016; 31: 343-350https://doi.org/10.1016/j.arth.2015.09.004
- Global forum: an international perspective on outpatient surgical procedures for adult hip and knee reconstruction.J Bone Joint Surg Am. 2016; 98: e55https://doi.org/10.2106/JBJS.15.00998
- Cost savings of outpatient versus standard inpatient total knee arthroplasty.Can J Surg. 2017; 60: 57-62
- Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients.J Arthroplasty. 2014; 29: 510-515https://doi.org/10.1016/j.arth.2013.07.020
- Outpatient total knee arthroplasty with a minimally invasive technique.J Arthroplasty. 2005; 20: 33-38https://doi.org/10.1016/j.arth.2005.05.021
- Association between hospital participation in a Medicare Bundled Payment Initiative and payments and quality outcomes for lower extremity joint replacement episodes.JAMA. 2016; 316: 1267https://doi.org/10.1001/jama.2016.12717
- Outpatient total hip arthroplasty.J Arthroplasty. 2010; 25: 501-506https://doi.org/10.1016/j.arth.2009.06.005
- A multi-center, prospective, randomized study of outpatient versus inpatient total hip arthroplasty.Clin Orthop Relat Res. 2016; : 1-9https://doi.org/10.1007/s11999-016-4915-z
- Same day total hip arthroplasty performed at an ambulatory surgical center: 90-day complication rate on 549 patients.J Arthroplasty. 2017; 32: 1103-1106https://doi.org/10.1016/j.arth.2016.10.013
- Comparison of outpatient versus inpatient total knee arthroplasty.Clin Orthopaedics Relat Res. 2009; 467: 1438-1442https://doi.org/10.1007/s11999-009-0730-0
- Safe selection of outpatient joint replacement patients with medical risk stratification: the “OARA score.”.J Arthroplasty. 2017; 89: 27https://doi.org/10.1016/j.arth.2017.03.004
- Is outpatient total hip arthroplasty safe?.J Arthroplasty. 2017; 32: 1439-1442https://doi.org/10.1016/j.arth.2016.11.053
- Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes.Orthopedics. 2016; 39: 223-228https://doi.org/10.3928/01477447-20160419-06
- American Society of Anaesthesiologists physical status classification.Indian J Anaesth. 2011; 55: 111-115https://doi.org/10.4103/0019-5049.79879
- Predictive factors of length of hospital stay after primary total knee arthroplasty.Knee Surgery, Sport Traumatol Arthrosc. 2015; 23: 1856-1862https://doi.org/10.1007/s00167-014-3313-x
- Safe selection of outpatient joint replacement patients with medical risk stratification: the “OARA score”.in: 2015 AAHKS Annual Meeting, Dallas, Texas. 2015
- Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients.Clin Orthopaedics Relat Res. 2009; 467: 1424-1430https://doi.org/10.1007/s11999-009-0741-x
- Total knee arthroplasty: improving outcomes with a multidisciplinary approach.J Multidiscip Healthc. 2018; 11: 63-73https://doi.org/10.2147/JMDH.S140550
- Impact of a clinical pathway and implant standardization on total hip arthroplasty a clinical and economic study of short-term patient outcome.J Arthroplasty. 1998; 13 ([accessed 09.02.18])
- Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty.([accessed 09.02.18])
- Reducing 30-day readmission after joint replacement.Orthop Clin North Am. 2016; 47: 673-680https://doi.org/10.1016/J.OCL.2016.05.014
- Does the risk assessment and prediction tool predict discharge disposition after joint replacement?.Clin Orthop Relat Res. 2015; 473: 597-601https://doi.org/10.1007/s11999-014-3851-z
- Acetabular fractures in the elderly: evaluation and management.J Bone Joint Surg Am. 2015; 97: 758-768https://doi.org/10.2106/JBJS.N.01037
- Patterns of ninety-day readmissions following total joint replacement in a Bundled Payment Initiative.J Arthroplasty. 2017; 32: 1080-1084https://doi.org/10.1016/j.arth.2016.10.027
- Complications following outpatient total joint arthroplasty: an analysis of a national database.J Arthroplasty. 2017; 32: 1426-1430https://doi.org/10.1016/j.arth.2016.11.055
- A preoperative scale for determining surgical readmission risk after total knee arthroplasty.https://doi.org/10.2106/JBJS.16.01043
Article info
Publication history
Published online: March 17, 2018
Accepted:
March 12,
2018
Received in revised form:
February 12,
2018
Received:
January 16,
2018
Footnotes
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.03.025.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
