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Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis.
J Arthroplasty. 2017 02; 32(2):375-380.JA

Abstract

BACKGROUND

Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care.

METHODS

Patients discharged home after elective primary THA/TKA from 2011 to 2014 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were performed using perioperative variables.

RESULTS

A total of 50,376 and 71,293 home-discharged THA and TKA patients were included for analysis, of which, 1575 THA (3.1%) and 2490 TKA (3.5%) patients suffered postdischarge severe complications or unplanned readmissions. These patients were older, smokers, obese, and functionally dependent (P < .001 for all). In multivariate analysis, severe adverse event predischarge, age, male gender, functional status, and 10 other variables were all associated with ≥1.22 odds of postdischarge severe adverse event or readmission (P < .05). THA and TKA patients with 2, 3, or ≥4 risk factors had 1.43-5.06 times odds of complications within 14 days post discharge and 1.41-3.68 times odds of complications beyond 14 days compared to those with 0 risk factors (P < .001 for all).

CONCLUSION

Risk factors can be used to predict which home-discharged TJA patients are at greatest risk of postdischarge complications. Given that this is a growing population, we recommend the development of formal risk-stratification protocols for home-discharged TJA patients.

Authors+Show Affiliations

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 Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27865568

Citation

Yao, Dong-Han, et al. "Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis." The Journal of Arthroplasty, vol. 32, no. 2, 2017, pp. 375-380.
Yao DH, Keswani A, Shah CK, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. J Arthroplasty. 2017;32(2):375-380.
Yao, D. H., Keswani, A., Shah, C. K., Sher, A., Koenig, K. M., & Moucha, C. S. (2017). Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. The Journal of Arthroplasty, 32(2), 375-380. https://doi.org/10.1016/j.arth.2016.08.004
Yao DH, et al. Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. J Arthroplasty. 2017;32(2):375-380. PubMed PMID: 27865568.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. AU - Yao,Dong-Han, AU - Keswani,Aakash, AU - Shah,Chirag K, AU - Sher,Alex, AU - Koenig,Karl M, AU - Moucha,Calin S, Y1 - 2016/08/27/ PY - 2016/06/06/received PY - 2016/07/29/revised PY - 2016/08/01/accepted PY - 2016/11/21/pubmed PY - 2017/12/15/medline PY - 2016/11/21/entrez KW - home discharge KW - home health KW - postdischarge complications KW - primary total joint arthroplasty KW - risk stratification KW - unplanned readmission SP - 375 EP - 380 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 2 N2 - BACKGROUND: Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care. METHODS: Patients discharged home after elective primary THA/TKA from 2011 to 2014 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were performed using perioperative variables. RESULTS: A total of 50,376 and 71,293 home-discharged THA and TKA patients were included for analysis, of which, 1575 THA (3.1%) and 2490 TKA (3.5%) patients suffered postdischarge severe complications or unplanned readmissions. These patients were older, smokers, obese, and functionally dependent (P < .001 for all). In multivariate analysis, severe adverse event predischarge, age, male gender, functional status, and 10 other variables were all associated with ≥1.22 odds of postdischarge severe adverse event or readmission (P < .05). THA and TKA patients with 2, 3, or ≥4 risk factors had 1.43-5.06 times odds of complications within 14 days post discharge and 1.41-3.68 times odds of complications beyond 14 days compared to those with 0 risk factors (P < .001 for all). CONCLUSION: Risk factors can be used to predict which home-discharged TJA patients are at greatest risk of postdischarge complications. Given that this is a growing population, we recommend the development of formal risk-stratification protocols for home-discharged TJA patients. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/27865568/Home_Discharge_After_Primary_Elective_Total_Joint_Arthroplasty:_Postdischarge_Complication_Timing_and_Risk_Factor_Analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(16)30478-8 DB - PRIME DP - Unbound Medicine ER -