Study finds decrease in length of hospital stay after hip replacement, but increase in readmissions

April 19, 2011, JAMA and Archives Journals

An analysis of data from Medicare beneficiaries who underwent hip replacement or subsequent follow-up corrective surgery between 1991 and 2008 indicates that the length of hospital stay after surgery declined during this time period, as did the proportion of patients discharged home, while there was an increase in the rate of hospital readmissions and discharge to a skilled care facility, according to a study in the April 20 issue of JAMA.

"Total hip arthroplasty [replacement] is a safe and effective therapy for patients with advanced degenerative joint disease. In recent years, there has been a dramatic increase in performance of this procedure both in the United States and abroad. There is a general assumption that increasing experience with total hip arthroplasty has resulted in improvements in patient outcomes, as has been observed in other procedures, but rigorous empirical data documenting such improvement are limited. This lack of data are striking given that an estimated 280,000 total hip arthroplasty procedures are performed annually at a cost of more than $12 billion," according to background information in the article.

Peter Cram, M.D., M.B.A., of the University of Iowa Carver College of Medicine, Iowa City, and colleagues evaluated the long-term trends in the outcomes of Medicare beneficiaries undergoing primary and revision (follow-up corrective surgery) total hip arthroplasty and to explore whether reductions in hospital length of stay (LOS) might be associated with increased discharge of patients to postacute care settings, increased readmission rates, or a combination of both outcomes. The study included data from between 1991 and 2008 on 1,453,493 Medicare Part A beneficiaries who underwent primary total hip arthroplasty and 348,596 who underwent revision total hip arthroplasty.

For primary total hip arthroplasty comparing 1991-1992 and 2007-2008, average age increased from 74.1 years to 75.1 years, and obesity prevalence increased from 2.2 percent to 7.6 percent, respectively. For revision total hip arthroplasty during these time periods, average age increased from 75.8 years to 77.3 years and obesity prevalence increased from 1.4 percent to 4.7 percent, respectively. For primary total hip arthroplasty, average hospital LOS decreased from 9.1 days to 3.7 days. After adjustment for patient characteristics, risk-adjusted 30-day mortality over the study period decreased from 0.7 percent to 0.3 percent and 90-day mortality decreased from 1.3 percent to 0.7 percent.

The researchers also found that the proportion of primary total hip arthroplasty patients discharged to home decreased from 68 percent in 1991-1992 to 48.2 percent in 2007-2008, while the proportion of patients discharged to skilled or intermediate care increased from 17.8 percent to 34.3 percent. The 30-day all-cause readmission rate decreased from 5.9 percent in 1991-1992 to 4.6 percent in 2001-2002, before increasing to 8.5 percent in 2007-2008. Results were similar for 90-day readmission rates.

"For revision total hip arthroplasty, similar trends were observed in hospital LOS, in-hospital mortality, discharge disposition, and hospital readmission rates," the authors write.

"In an analysis of 1991-2008 Medicare administrative data, 3 trends were identified. First, we found that despite increasing patient complexity, both unadjusted and adjusted mortality for primary total hip arthroplasty showed substantial improvement over time. Conversely, our second finding was that for revision total hip arthroplasty, unadjusted mortality appeared to increase modestly but this increase was largely explained by increasing patient complexity. Third and most importantly, marked declines in hospital LOS for both primary and revision total hip arthroplasty seemed to correspond with an increase in the proportion of patients who were discharged to postacute care and an increase in patient readmissions."

Explore further: New study finds low mortality risk following knee and hip replacement

More information: JAMA. 2011;305[15]1560-1567.

Related Stories

New study finds low mortality risk following knee and hip replacement

January 4, 2010
Total hip and total knee replacement surgeries are highly successful and very common procedures for people experiencing pain associated with degenerative joints. With a new hip or knee, and postoperative care prescribed ...

'Shrug off' shoulder surgery myth, study suggests

March 26, 2007
Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests.

For heart failure patients, risk of in-hospital death has decreased; readmission rate has increased

June 1, 2010
An analysis of Medicare data from 1993 through 2006 for older patients hospitalized for heart failure indicates that along with a decrease in hospital length of stay, the rate of in-hospital and 30-day mortality has decreased, ...

Total knee replacement appears cost-effective in older adults

June 22, 2009
Total knee replacement (arthroplasty) appears to be a cost-effective procedure for older adults with advanced osteoarthritis, according to a report in the June 22 issue of Archives of Internal Medicine, one of the JAMA/Archives ...

Many knee and hip replacement patients experience weight decrease after surgery

July 26, 2010
A Mount Sinai School of Medicine study has found that patients often exhibit a significant decrease in weight and body mass index (BMI) after undergoing knee or hip replacement surgery (arthroplasty). The study is the first ...

Obese patients face increased risks for infection and dislocation following revision hip surgery

May 8, 2008
Along with age and injuries, obesity is a leading risk factor for osteoarthritis (OA), a painful and disabling joint disease. While excessive weight can aggravate the toll on almost any joint, obesity has been associated ...

Recommended for you

How do babies laugh? Like chimps!

November 7, 2018
Few things can delight an adult more easily than the uninhibited, effervescent laughter of a baby. Yet baby laughter, a new study shows, differs from adult laughter in a key way: Babies laugh as they both exhale and inhale, ...

Tongue-in-cheek Nobels honor nutritional analysis of cannibalism, roller-coaster kidney stones treatment

September 14, 2018
A nutritional analysis of cannibalism and treating kidney stones on roller-coasters were research projects honored by tongue-in-cheek awards at Harvard University Thursday, designed to make you laugh first, and think later.

Pediatric robot patient offers new level of realism for doctors in training

September 10, 2018
A team of researchers and engineers at Gaumard Scientific has unveiled a new robot that raises the bar on medical training devices. The robot, called HAL, has been made to look like a five-year-old male patient and offers ...

Why men say they've had more lifetime sexual partners than women

July 25, 2018
The disparity between the number of sexual partners reported by men and women can largely be explained by a tendency among men to report extreme numbers of partners, and to estimate rather than count their lifetime total, ...

Censors jump into action as China's latest vaccine scandal ignites

July 22, 2018
Chinese censors on Sunday deleted articles and postings about the vaccine industry as an online outcry over the country's latest vaccine scandal intensified.

Revenge of a forgotten medical 'genius'

June 30, 2018
It's not an uncommon fate for a pioneering scientist: languishing unrecognised in his time before dying in obscurity. But as his 200th birthday approaches, the life-saving work of a Hungarian obstetrician is finally getting ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.