Knee surgeries double as hospital stays drop, readmissions rise

The number of total knee replacements has significantly increased over two decades, according to a study published today in the Journal of the American Medical Association. Despite a shorter length of stay after knee replacements, readmission and infection rates rose during the 20-year period.

Researchers found that primary total knee replacement procedures jumped 161.5 percent between 1991 and 2010, while revision surgeries increased 105.9 percent. The jump likely stems from an aging populating coupled with a growing prevalence of obesity and other conditions that take a toll on joints, according to the research announcement.

The good news is the average hospital length of stay for primary total knee replacements fell from 7.9 days to 3.5 days. However, all-cause 30-day readmission to the hospital increased from 4.2 percent to 5 percent.

"I think there is definitely the hint in there that we are now discharging people so quickly that more of them are requiring readmission," lead researcher Peter Cram, health policy researcher and internist at the University of Iowa Carver College of Medicine, told The Wall Street Journal.

And with total knee replacement as one of the nation's most common and costly surgical procedures, the industry can only afford so many total knee replacements, Cram noted. But limiting the procedure and deciding who should receive it will be "really contentious debate," he said, the WSJ noted.

Hospitals should pay attention to this fast-growing procedure, given that knee replacements and other orthopedic procedures are an audit hotspot, according to FierceHealthFinance's eBook, "Best Practices for Surviving Audits and Denials."

Hospitals can help patients decide whether such treatment is the best option for them. A large health system in Washington State found that suggesting osteoarthritis patients use decision aids before undergoing treatment led to fewer knee and hip replacements and lower costs, according to a study this month in Health Affairs. With video-based aids that present the pros and cons of treatment options, knee replacement surgeries dropped 38 percent, and costs fell between 12 percent and 21 percent.

For more:
- here's the study abstract and announcement
- read the WSJ article (registration required)