Is a shortened length of stay and increased rate of discharge to home associated with a low readmission rate and cost-effectiveness after primary total knee arthroplasty?

Background It is controversial whether shortening the average length of hospital stay and increasing discharge from a rehabilitation facility to home with either health care or outpatient physical therapy is safe and cost-effective. Methods We computed the average length of hospital stay; the rate of discharge to a rehabilitation facility, home with health care, or home with outpatient physical therapy; the all-cause readmission rate within 30 days of discharge per year; and cost savings for 2328 consecutive patients treated with a unilateral primary total knee replacement between 2009 and 2014. Results The average length of hospital stay per year shortened from 2.0 to 1.3 days (P < .0001); the rate of discharge per year to a rehabilitation facility decreased from 41% to 1% and increased from 9% to 53% to home with outpatient physical therapy (P < .0001); and the rate of readmission within 30 days per year did not change (P = .38). The cost savings averaged $3245 per patient. Conclusions A shorter length of hospital stay and an increased rate of discharge to home was not associated with an increased rate of readmission within 30 days and was cost-effective. Level of Evidence Level IV, Therapeutic study.