Current Evidence Does Not Support Medicare's 3-Day Rule in Primary Total Joint Arthroplasty.

American journal of orthopedics (Belle Mead, N.J.)

PubMedID: 26447413

Halawi MJ, Vovos TJ, Green CL, Wellman SS, Attarian DE, Bolognesi MP. Current Evidence Does Not Support Medicare's 3-Day Rule in Primary Total Joint Arthroplasty. Am J Orthop. 2015;44(10):E370-2.
Patients who undergo total joint arthroplasty and are destined for discharge to an extended-care facility-particularly Medicare beneficiaries-are required to have an inpatient stay of at least 3 consecutive days. The primary objective of this study was to explore the effect of this policy on length of stay. SECONDARY OUTCOMES
were 30-day readmission rate and inpatient rehabilitation gains.We retrospectively reviewed 284 consecutive cases of patients who underwent primary total hip or knee arthroplasty and were discharged to an extended-care facility. Based on readiness-for-discharge criteria, delaying discharge until postoperative day 3 increased length of stay by 1. 08 days (P <. 001) and had no effect on risk for 30-day readmission (P =. 073). Although rehabilitation status improved with stays past discharge readiness (P =. 038), the gains were not clinically sufficient to affect discharge destination. This study calls into question the validity of Medicare's 3-day rule in primary total joint arthroplasty. Larger, prospective, multicenter studies are needed to confirm these findings.