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Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends.
J Arthroplasty. 2016 06; 31(6):1155-1162.JA

Abstract

BACKGROUND

This study aimed to compare risk of postdischarge adverse events in elective total joint arthroplasty (TJA) patients by discharge destination, identify risk factors for inpatient discharge placement and postdischarge adverse events, and stratify TJA patients based on these risk factors to identify the most appropriate discharge destination.

METHODS

Patients who underwent elective primary total hip or knee arthroplasty from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were assessed using perioperative variables.

RESULTS

A total of 106,360 TJA patients were analyzed. The most common discharge destinations included home (70%), skilled nursing facility (SNF) (19%), and inpatient rehabilitation facility (IRF; 11%). Bivariate analysis revealed that rates of postdischarge adverse events were higher in SNF and IRF patients (all P ≤ .001). In multivariate analysis controlling for patient characteristics, comorbidities, and incidence of complication predischarge, SNF and IRF patients were more likely to have postdischarge severe adverse events (SNF: odds ratio [OR]: 1.46, P ≤ .001; IRF: OR: 1.59, P ≤ .001) and unplanned readmission (SNF: OR: 1.42, P ≤ .001; IRF: OR: 1.38, P ≤ .001). After stratifying patients by strongest independent risk factors (OR: ≥1.15, P ≤ .05) for adverse outcomes after discharge, we found that home discharge is the optimal strategy for minimizing rate of severe 30-day adverse events after discharge (P ≤ .05 for 5 out of 6 risk levels) and unplanned 30-day readmissions (P ≤ .05 for 6 out of 7 risk levels). Multivariate analysis revealed incidence of severe adverse events predischarge, female gender, functional status, body mass index >40, smoking, diabetes, pulmonary disease, hypertension, and American Society of Anesthesiologists class 3/4 as independent predictors of nonhome discharge (all P ≤ .001).

CONCLUSION

SNF or IRF discharge increases the risk of postdischarge adverse events compared to home. Modifiable risk factors for nonhome discharge and postdischarge adverse events should be addressed preoperatively to improve patient outcomes across discharge settings.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26860962

Citation

Keswani, Aakash, et al. "Discharge Destination After Total Joint Arthroplasty: an Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends." The Journal of Arthroplasty, vol. 31, no. 6, 2016, pp. 1155-1162.
Keswani A, Tasi MC, Fields A, et al. Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. J Arthroplasty. 2016;31(6):1155-1162.
Keswani, A., Tasi, M. C., Fields, A., Lovy, A. J., Moucha, C. S., & Bozic, K. J. (2016). Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. The Journal of Arthroplasty, 31(6), 1155-1162. https://doi.org/10.1016/j.arth.2015.11.044
Keswani A, et al. Discharge Destination After Total Joint Arthroplasty: an Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. J Arthroplasty. 2016;31(6):1155-1162. PubMed PMID: 26860962.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends. AU - Keswani,Aakash, AU - Tasi,Michael C, AU - Fields,Adam, AU - Lovy,Andrew J, AU - Moucha,Calin S, AU - Bozic,Kevin J, Y1 - 2016/01/20/ PY - 2015/09/25/received PY - 2015/11/24/revised PY - 2015/11/30/accepted PY - 2016/2/11/entrez PY - 2016/2/11/pubmed PY - 2017/10/11/medline KW - complication KW - discharge destination KW - discharge disposition KW - inpatient rehab facility KW - readmission KW - skilled nursing facility SP - 1155 EP - 1162 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 31 IS - 6 N2 - BACKGROUND: This study aimed to compare risk of postdischarge adverse events in elective total joint arthroplasty (TJA) patients by discharge destination, identify risk factors for inpatient discharge placement and postdischarge adverse events, and stratify TJA patients based on these risk factors to identify the most appropriate discharge destination. METHODS: Patients who underwent elective primary total hip or knee arthroplasty from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were assessed using perioperative variables. RESULTS: A total of 106,360 TJA patients were analyzed. The most common discharge destinations included home (70%), skilled nursing facility (SNF) (19%), and inpatient rehabilitation facility (IRF; 11%). Bivariate analysis revealed that rates of postdischarge adverse events were higher in SNF and IRF patients (all P ≤ .001). In multivariate analysis controlling for patient characteristics, comorbidities, and incidence of complication predischarge, SNF and IRF patients were more likely to have postdischarge severe adverse events (SNF: odds ratio [OR]: 1.46, P ≤ .001; IRF: OR: 1.59, P ≤ .001) and unplanned readmission (SNF: OR: 1.42, P ≤ .001; IRF: OR: 1.38, P ≤ .001). After stratifying patients by strongest independent risk factors (OR: ≥1.15, P ≤ .05) for adverse outcomes after discharge, we found that home discharge is the optimal strategy for minimizing rate of severe 30-day adverse events after discharge (P ≤ .05 for 5 out of 6 risk levels) and unplanned 30-day readmissions (P ≤ .05 for 6 out of 7 risk levels). Multivariate analysis revealed incidence of severe adverse events predischarge, female gender, functional status, body mass index >40, smoking, diabetes, pulmonary disease, hypertension, and American Society of Anesthesiologists class 3/4 as independent predictors of nonhome discharge (all P ≤ .001). CONCLUSION: SNF or IRF discharge increases the risk of postdischarge adverse events compared to home. Modifiable risk factors for nonhome discharge and postdischarge adverse events should be addressed preoperatively to improve patient outcomes across discharge settings. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/26860962/Discharge_Destination_After_Total_Joint_Arthroplasty:_An_Analysis_of_Postdischarge_Outcomes_Placement_Risk_Factors_and_Recent_Trends_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(15)01099-2 DB - PRIME DP - Unbound Medicine ER -