Health Policy & EconomicsDischarge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends
Section snippets
Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2011 to 2013. The TKA cohort was identified using the common procedural terminology code corresponding to primary TKA (27447). The THA cohort was similarly identified using the common procedural terminology code (27130). Patients with incomplete data or who underwent nonelective TJA were
Results
A total of 64,763 TKA and 41,597 THA patients were included for analysis. The most common discharge destinations were home (70%), SNF (19%), and IRF (11%). Bivariate analysis revealed that nonhome discharge destination (IRF or SNF) patients tended to be older, female, functionally dependent, and morbidly obese (body mass index [BMI], >40) as compared to patients discharged home (all P < .001; Table 1). Nonhome TJA patients had increased rates of diabetes, pulmonary disease, cardiac disease,
Discussion
Many recent policy initiatives have focused on TJA because of the high cost, prevalence, and relative clinical homogeneity of this procedure. Understanding variability in care processes, costs, and outcomes is a critical step in optimizing the value of care for TJA patients [8]. Post–acute care accounts for almost half of the total TJA costs, largely due to the use of IRF and SNF. In this context, understanding the value post–acute care facilities provide will be required to optimize discharge
Conclusion
SNF and IRF discharge destinations are independent risk factors for 30-day readmission and postdischarge severe adverse events. Across patient risk levels, TJA patients discharged home tend to have the lowest rates of 30-day readmission and postdischarge severe adverse events. Modifiable patient risk factors such as morbid obesity, smoking, diabetes, pulmonary disease, and hypertension should be optimized during the preoperative period to reduce risk of nonhome discharge and adverse events.
References (31)
- et al.
Joint replacement rehabilitation outcomes on discharge from skilled nursing facilities and inpatient rehabilitation facilities
Arch Phys Med Rehabil
(2009) - et al.
Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty
J Arthroplasty
(2006) - et al.
Factors determining discharge destination for patients undergoing total joint arthroplasty
J Arthroplasty
(2014) - et al.
Targeted postoperative care improves discharge outcome after hip or knee arthroplasty
Arch Phys Med Rehabil
(2004) - et al.
Does discharge disposition after primary total joint arthroplasty affect readmission rates?
J Arthroplasty
(2010) - et al.
The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty
J Arthroplasty
(2014) - et al.
A comparison of discharge functional status after rehabilitation in skilled nursing, home health, and medical rehabilitation settings for patients after lower-extremity joint replacement surgery
Arch Phys Med Rehabil
(2011) - et al.
Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030
J Bone Joint Surg Am
(2007) - et al.
Medicare's bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin
Health Aff
(2011) - et al.
Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction
Clin Orthop Relat Res
(2014)
Associations between preoperative physical therapy and post-acute care utilization patterns and cost in total joint replacement
J Bone Joint Surg Am
What is value in health care?
N Engl J Med
Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients
J Orthop Trauma
Special issue on current challenges and future directions in monitoring responses after treatment of primary cancer
J Cancer
Determinants of discharge destination following elective total hip replacement
Arthritis Rheum
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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.11.044.