Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List
Background: Total hip arthroplasty (THA) was removed from the Centers for Medicare and Medicaid Services inpatient-only (IPO) list on January 1, 2020. The impact of this policy changes on length of stay (LOS) and coding status (inpatient/outpatient) beyond 2020 remains to be fully defined. Methods:...
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Elsevier
2024-12-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S235234412400253X |
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| author | Joshua G. Sanchez, BA Meera M. Dhodapkar, MD Scott J. Halperin, MD Will M. Jiang, BS Jonathan N. Grauer, MD Lee E. Rubin, MD |
| author_facet | Joshua G. Sanchez, BA Meera M. Dhodapkar, MD Scott J. Halperin, MD Will M. Jiang, BS Jonathan N. Grauer, MD Lee E. Rubin, MD |
| author_sort | Joshua G. Sanchez, BA |
| collection | DOAJ |
| description | Background: Total hip arthroplasty (THA) was removed from the Centers for Medicare and Medicaid Services inpatient-only (IPO) list on January 1, 2020. The impact of this policy changes on length of stay (LOS) and coding status (inpatient/outpatient) beyond 2020 remains to be fully defined. Methods: Data were obtained from the 2018 to 2021 National Surgical Quality Improvement Program database. Elective primary THA patients aged 18 y or older were identified by Current Procedural Terminology code. Year of surgery, age (dichotomized at ≥/<65 y old), American Society of Anesthesiologists classification, smoking status, coding status, and LOS were assessed. Pearson chi-squared tests compared categorical variables, while analysis of variance tests evaluated continuous variables. Results: Overall, 156,212 THA patients were identified. Over the 4 y of study, outpatient cases increased by 1392% from 3.7%-5.75% to 35.6%-54.2% (P < .0001). Analogously, average LOS decreased from 1.91-1.75 to 1.50-1.35 d (P < .0001). This pattern of decreased LOS was seen in patients aged ≥65 y (traditional Medicare eligibility, P < .0001) and those <65. Conclusions: These data demonstrate a continued increase in outpatient THA since the IPO list removal, with over half of cases classified as outpatient in 2021 and a corresponding reduction in LOS. Notably, the outpatient status is an administrative designation that was not defined by same-day discharge or lack of overnight stay. The observed changes in both age groups (≥65 and <65 y) underscore the extensive impact of the IPO list removal on surgical practices. |
| format | Article |
| id | doaj-art-fd4734cdc32a45e3a9a2814d8f607ffb |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-fd4734cdc32a45e3a9a2814d8f607ffb2024-12-19T10:55:26ZengElsevierArthroplasty Today2352-34412024-12-0130101568Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only ListJoshua G. Sanchez, BA0Meera M. Dhodapkar, MD1Scott J. Halperin, MD2Will M. Jiang, BS3Jonathan N. Grauer, MD4Lee E. Rubin, MD5Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USAYale Department of Orthopaedics and Rehabilitation, New Haven, CT, USAYale Department of Orthopaedics and Rehabilitation, New Haven, CT, USAYale Department of Orthopaedics and Rehabilitation, New Haven, CT, USACorresponding author. Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06511, USA. Tel.: +1 203 737 7463.; Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USAYale Department of Orthopaedics and Rehabilitation, New Haven, CT, USABackground: Total hip arthroplasty (THA) was removed from the Centers for Medicare and Medicaid Services inpatient-only (IPO) list on January 1, 2020. The impact of this policy changes on length of stay (LOS) and coding status (inpatient/outpatient) beyond 2020 remains to be fully defined. Methods: Data were obtained from the 2018 to 2021 National Surgical Quality Improvement Program database. Elective primary THA patients aged 18 y or older were identified by Current Procedural Terminology code. Year of surgery, age (dichotomized at ≥/<65 y old), American Society of Anesthesiologists classification, smoking status, coding status, and LOS were assessed. Pearson chi-squared tests compared categorical variables, while analysis of variance tests evaluated continuous variables. Results: Overall, 156,212 THA patients were identified. Over the 4 y of study, outpatient cases increased by 1392% from 3.7%-5.75% to 35.6%-54.2% (P < .0001). Analogously, average LOS decreased from 1.91-1.75 to 1.50-1.35 d (P < .0001). This pattern of decreased LOS was seen in patients aged ≥65 y (traditional Medicare eligibility, P < .0001) and those <65. Conclusions: These data demonstrate a continued increase in outpatient THA since the IPO list removal, with over half of cases classified as outpatient in 2021 and a corresponding reduction in LOS. Notably, the outpatient status is an administrative designation that was not defined by same-day discharge or lack of overnight stay. The observed changes in both age groups (≥65 and <65 y) underscore the extensive impact of the IPO list removal on surgical practices.http://www.sciencedirect.com/science/article/pii/S235234412400253XTotal hip arthroplastyMedicareInpatient-only listCMSLength of stayPolicy |
| spellingShingle | Joshua G. Sanchez, BA Meera M. Dhodapkar, MD Scott J. Halperin, MD Will M. Jiang, BS Jonathan N. Grauer, MD Lee E. Rubin, MD Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List Arthroplasty Today Total hip arthroplasty Medicare Inpatient-only list CMS Length of stay Policy |
| title | Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List |
| title_full | Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List |
| title_fullStr | Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List |
| title_full_unstemmed | Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List |
| title_short | Trends in Total Hip Arthroplasty Length of Stay and Coding Status From 2018 to 2021: Two-Year Impact of the Removal From the Inpatient-Only List |
| title_sort | trends in total hip arthroplasty length of stay and coding status from 2018 to 2021 two year impact of the removal from the inpatient only list |
| topic | Total hip arthroplasty Medicare Inpatient-only list CMS Length of stay Policy |
| url | http://www.sciencedirect.com/science/article/pii/S235234412400253X |
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