Tempering Expectations for Outpatient Total Knee Arthroplasty for Patients Over 70

Published:January 10, 2022DOI:https://doi.org/10.1016/j.arth.2022.01.004

      Abstract

      Background

      Total knee arthroplasty (TKA) is now considered an outpatient procedure, yet advanced age impacts patients’ ability to achieve outpatient discharge. Therefore, the purpose of this study was to determine the rate of successful outpatient discharge for TKA patients above 70 years of age and identify potential barriers to success.

      Methods

      This retrospective review included 352 unilateral TKA patients. The rapid discharge protocol was followed for all patients with the intention of discharge within a 24-hour period. Successful outpatient discharge was classified as ≤24 hour stay and failure was any stay exceeding a 24 hour period in the hospital. Univariate logistic regressions were performed to determine the influence of independent variables on discharge status for all patients and only patients over 70 years old.

      Results

      Overall, 46 patients (13%) failed to achieve outpatient discharge, with 35 (76%) patients being ≥70 years old. For patients ≥70, age was not a predictive variable for failure to achieve outpatient discharge (p=0.484). However, being female [Odds Ratio (OR): 3.273, 95% Confidence Interval (CI): 1.286-8.325; p=0.013] and the use of an assistive walking device [OR: 3.031, CI: 1.387-6.625; p=0.005] remained independent contributors to prolonged hospital stay.

      Conclusion

      With patients ≥70 years old more likely to require >24 hour stays, age should be an evaluated metric for justifying higher levels of reimbursement. Although TKA is now considered an outpatient procedure, greater consideration should be given to patients ≥70 years old for higher levels of reimbursement as outpatient discharge is less likely to be successful.

      Keywords

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