Changes in Payment Regulation and Acute Care Use for Total Hip Replacement: Trends in Length of Stay, Costs, and Discharge, 1997-2012

PurposeTo describe trends in the length of stay (LOS), costs, mortality, and discharge destination among a national sample of total hip replacement (THR) patients between 1997 and 2012. DesignLongitudinal retrospective design MethodsDescriptive analysis of the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample data. FindingsA total of 3,516,636 procedures were performed over the study period. Most THR patients were women, and the proportion aged 44-65years increased. LOS decreased from 5 to 3days. Charges more than doubled, from $22,184 to $53,901. Deaths decreased from 43 to 12 deaths per 10,000 patients. THR patients discharged to an institutional setting declined, while those discharged to the community increased. ConclusionWe found an increase in THR patients, who were younger, women, had private insurance, and among those discharged to community-based settings. Clinical RelevanceFindings have implications for patient profiles, workplace environments, quality improvement, and educational preparation of nurses in acute and postacute settings.