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Shorter Hospital Stays, More Readmissions After Hip Replacements
Date:4/19/2011

By Serena Gordon
HealthDay Reporter

TUESDAY, April 19 (HealthDay News) -- People who have hip replacement surgery now spend far shorter recovery time in hospital than they did almost two decades ago, but discharges to nursing facilities and readmissions to hospitals have soared as a result, Iowa researchers report.

Using Medicare data on more than 1 million hip surgeries done between 1991 and 2008, the researchers found that hospital stays are now averaging under four days, compared to more than nine days in the 20th century. However, the number of hip-surgery patients discharged to a skilled nursing facility nearly doubled during that time frame, from 17.8 percent to 34.3 percent; hospital readmission rates went from 5.9 percent to 8.5 percent; and the percentage of those discharged home decreased dramatically, from 68 percent to 48.2 percent.

"Both primary and revision hip arthroplasty are safe and mortality is low, but hospital stays are [now] extremely short. And, as patients' length of stays go down, there's less time to recuperate, and even if they're not yet ready to go home, they have to go somewhere else quickly, and more are being admitted to rehabilitation centers," explained the study's lead author, Dr. Peter Cram, an associate professor in the division of general internal medicine at the University of Iowa Carver College of Medicine in Iowa City.

"This is part of what's so complicated in the political discussions on healthcare," he added. "You're really just squeezing a balloon here. If we reduce the length of stay in the hospital, we can save money, or at least it seems like a way to save money. But, when we squeeze the balloon on one end to reduce length of stay, other costs pop up on the other side of the balloon."

Pointing to the increased hospital readmissions and discharges to nursing homes, he said, "This is why it's so hard to reduce or contain healthcare costs."

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