• John A Batsis, James M Naessens, Mark T Keegan, Paul M Huddleston, Amy E Wagie, and Jeanne M Huddleston.
• Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
• J Hosp Med. 2008 May 1;3(3):218-27.

BackgroundThe use of specialized orthopedic surgery (SOS) units in total knee arthroplasty (TKA) patients is well established. The number and costs of arthoplasty surgeries continue to increase, requiring institutions to reexamine their existing practices for financial sustainability.ObjectiveThe objective of this study was to determine whether having elective TKA patients in SOS units affects resource utilization and outcomes.DesignThe study was designed to retrospectively compare elective TKA patients from 1996 to 2004 admitted directly to SOS units with those admitted to nonorthopedic nursing (NON) units.SettingThe setting was an academic teaching hospital.PatientsFive thousand five hundred and thirty-four patients met inclusion criteria. Of these, 5082 (patients 91.8%) were admitted to SOS units and 452 (8.2%) to NON units.MeasurementsThe primary outcomes measured were length of stay (LOS) and costs, adjusted for age, sex, surgical year, comorbidities, and American Society of Anesthesiologists status. Secondary outcomes were 30-day mortality, readmissions, reoperations, and discharge disposition.ResultsMean age of the patients in SOS and NON units was 68.3 and 67.9 years, respectively (P = .50). Adjusted LOS was 0.234 days shorter in SOS units (95% CI: 0.083, 0.385). Adjusted total and hospital cost savings in the SOS unit group were $600 (95% CI: $122, $1079) and $594 (95% CI: $141, $1047), respectively. More NON-unit patients required unanticipated transfers to the intensive care unit (ICU) from the general postoperative nursing unit (3.1% vs. 1.63%; P = .023); however, the mean number of ICU days did not differ between groups. NON-unit patients were more likely to be discharged with home health care (P < .001). There were no differences in 30-day outcomes.ConclusionsPatients on SOS units following elective TKA have a reduced LOS and decreased total and hospital costs. Our results should encourage hospitals to reevaluate postoperative patient flow to optimize resource utilization.(c) 2008 Society of Hospital Medicine

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