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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Halawi, MJ; Vovos, TJ; Green, CL; Wellman, SS; Attarian, DE; Bolognesi, MP

Published Date

  • October 2015

Published In

Volume / Issue

  • 44 / 10

Start / End Page

  • E370 - E372

PubMed ID

  • 26447413

Electronic International Standard Serial Number (EISSN)

  • 1934-3418


  • eng

Conference Location

  • United States