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Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis.
J Arthroplasty. 2017 09; 32(9S):S113-S118.JA

Abstract

BACKGROUND

Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination.

METHODS

All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database. Propensity scores based on predischarge characteristics were used to adjust for selection bias in discharge destination. Propensity-adjusted multivariable logistic regressions were used to examine associations between discharge destination and postdischarge complications.

RESULTS

Among 101,256 primary TKAs identified, 70,628 were discharged home and 30,628 to skilled care facilities. Patients discharged to facilities were more frequently were female, older, higher body mass index class, higher Charlson comorbidity index and American Society of Anesthesiologists scores, had predischarge complications, received general anesthesia, and classified as nonindependent preoperatively. Propensity adjustment accounted for this selection bias. Patients discharged to skilled care facilities after TKA had higher odds of any major complication (odds ratio = 1.25; 95% confidence interval, 1.13-1.37) and readmission (odds ratio = 1.81; 95% confidence interval, 1.50-2.18). Skilled care was associated with increased odds for respiratory, septic, thromboembolic, and urinary complications. Associations with death, cardiac, and wound complications were not significant.

CONCLUSION

After controlling for predischarge characteristics, discharge to skilled care facilities vs home after primary TKA is associated with higher odds of numerous complications and unplanned readmission. These results support coordination of care pathways to facilitate home discharge after hospitalization for TKA whenever possible.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.Chief Value Medical Officer, Hospital for Special Surgery, New York, New York.Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28285902

Citation

McLawhorn, Alexander S., et al. "Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: a Propensity Score-Adjusted Analysis." The Journal of Arthroplasty, vol. 32, no. 9S, 2017, pp. S113-S118.
McLawhorn AS, Fu MC, Schairer WW, et al. Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis. J Arthroplasty. 2017;32(9S):S113-S118.
McLawhorn, A. S., Fu, M. C., Schairer, W. W., Sculco, P. K., MacLean, C. H., & Padgett, D. E. (2017). Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis. The Journal of Arthroplasty, 32(9S), S113-S118. https://doi.org/10.1016/j.arth.2017.01.039
McLawhorn AS, et al. Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: a Propensity Score-Adjusted Analysis. J Arthroplasty. 2017;32(9S):S113-S118. PubMed PMID: 28285902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis. AU - McLawhorn,Alexander S, AU - Fu,Michael C, AU - Schairer,William W, AU - Sculco,Peter K, AU - MacLean,Catherine H, AU - Padgett,Douglas E, Y1 - 2017/02/01/ PY - 2016/12/15/received PY - 2017/01/22/accepted PY - 2017/3/14/pubmed PY - 2018/4/18/medline PY - 2017/3/14/entrez KW - aftercare KW - alternative payment models KW - episode of care KW - medicare KW - postoperative complications KW - total knee arthroplasty SP - S113 EP - S118 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9S N2 - BACKGROUND: Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in postacute care outcomes. The purpose of this study was to characterize the 30-day postdischarge outcomes after primary TKA relative to discharge destination. METHODS: All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database. Propensity scores based on predischarge characteristics were used to adjust for selection bias in discharge destination. Propensity-adjusted multivariable logistic regressions were used to examine associations between discharge destination and postdischarge complications. RESULTS: Among 101,256 primary TKAs identified, 70,628 were discharged home and 30,628 to skilled care facilities. Patients discharged to facilities were more frequently were female, older, higher body mass index class, higher Charlson comorbidity index and American Society of Anesthesiologists scores, had predischarge complications, received general anesthesia, and classified as nonindependent preoperatively. Propensity adjustment accounted for this selection bias. Patients discharged to skilled care facilities after TKA had higher odds of any major complication (odds ratio = 1.25; 95% confidence interval, 1.13-1.37) and readmission (odds ratio = 1.81; 95% confidence interval, 1.50-2.18). Skilled care was associated with increased odds for respiratory, septic, thromboembolic, and urinary complications. Associations with death, cardiac, and wound complications were not significant. CONCLUSION: After controlling for predischarge characteristics, discharge to skilled care facilities vs home after primary TKA is associated with higher odds of numerous complications and unplanned readmission. These results support coordination of care pathways to facilitate home discharge after hospitalization for TKA whenever possible. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28285902/Continued_Inpatient_Care_After_Primary_Total_Knee_Arthroplasty_Increases_30_Day_Post_Discharge_Complications:_A_Propensity_Score_Adjusted_Analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30071-2 DB - PRIME DP - Unbound Medicine ER -