Tags

Type your tag names separated by a space and hit enter

Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity.
J Arthroplasty. 2017 09; 32(9S):S144-S149.e1.JA

Abstract

BACKGROUND

Discharge disposition accounts for significant variability in costs after elective total hip arthroplasty (THA). Therefore, institutions must evaluate the short-term clinical outcomes associated with postdischarge care options. The present study intends to characterize the associations between short-term morbidity after primary THA and discharge destination.

METHODS

Primary elective unilateral THA cases performed for osteoarthritis were identified in the American College of Surgeons National Surgical Quality Improvement Program registry from 2011 to 2014. Propensity scores were used to adjust for selection bias in discharge destination, based on demographics, obesity class, preoperative functional status, modified Charlson comorbidity index, American Society of Anesthesiologists (ASA) class, and the presence of predischarge complications. Propensity-adjusted multivariate logistic regressions were used to examine associations between discharge destination and postdischarge complications, controlling for selection bias based on observable patient characteristics.

RESULTS

Among 54,837 THA cases included in the study, 40,576 (74%) were discharged home, and 14,261 (26%) were discharged to inpatient facilities. In multivariate propensity-adjusted analyses, patients discharged to continued inpatient care after THA were more likely to have septic complications (odds ratio, 2.34; 95% confidence interval, 1.58-3.45), urinary complications (1.51; 1.21-1.90), readmission (1.44; 1.29-1.59), wound complications (1.31; 1.09-1.57), and respiratory complications (1.93; 1.21-3.07).

CONCLUSION

Discharge to continued inpatient care following THA is associated with increased odds of postdischarge morbidity and unplanned readmission, after propensity score adjustment for predischarge characteristics. Additional research is needed on the impact of devoting resources toward facilitating discharge to home after THA.

Authors+Show Affiliations

Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.Division of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28455181

Citation

Fu, Michael C., et al. "Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity." The Journal of Arthroplasty, vol. 32, no. 9S, 2017, pp. S144-S149.e1.
Fu MC, Samuel AM, Sculco PK, et al. Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity. J Arthroplasty. 2017;32(9S):S144-S149.e1.
Fu, M. C., Samuel, A. M., Sculco, P. K., MacLean, C. H., Padgett, D. E., & McLawhorn, A. S. (2017). Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity. The Journal of Arthroplasty, 32(9S), S144-e1. https://doi.org/10.1016/j.arth.2017.03.044
Fu MC, et al. Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity. J Arthroplasty. 2017;32(9S):S144-S149.e1. PubMed PMID: 28455181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Discharge to Inpatient Facilities After Total Hip Arthroplasty Is Associated With Increased Postdischarge Morbidity. AU - Fu,Michael C, AU - Samuel,Andre M, AU - Sculco,Peter K, AU - MacLean,Catherine H, AU - Padgett,Douglas E, AU - McLawhorn,Alexander S, Y1 - 2017/03/27/ PY - 2017/01/12/received PY - 2017/02/20/revised PY - 2017/03/17/accepted PY - 2017/4/30/pubmed PY - 2018/4/18/medline PY - 2017/4/30/entrez KW - complications KW - discharge destination KW - hip arthroplasty KW - readmission KW - rehabilitation KW - total hip arthroplasty SP - S144 EP - S149.e1 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9S N2 - BACKGROUND: Discharge disposition accounts for significant variability in costs after elective total hip arthroplasty (THA). Therefore, institutions must evaluate the short-term clinical outcomes associated with postdischarge care options. The present study intends to characterize the associations between short-term morbidity after primary THA and discharge destination. METHODS: Primary elective unilateral THA cases performed for osteoarthritis were identified in the American College of Surgeons National Surgical Quality Improvement Program registry from 2011 to 2014. Propensity scores were used to adjust for selection bias in discharge destination, based on demographics, obesity class, preoperative functional status, modified Charlson comorbidity index, American Society of Anesthesiologists (ASA) class, and the presence of predischarge complications. Propensity-adjusted multivariate logistic regressions were used to examine associations between discharge destination and postdischarge complications, controlling for selection bias based on observable patient characteristics. RESULTS: Among 54,837 THA cases included in the study, 40,576 (74%) were discharged home, and 14,261 (26%) were discharged to inpatient facilities. In multivariate propensity-adjusted analyses, patients discharged to continued inpatient care after THA were more likely to have septic complications (odds ratio, 2.34; 95% confidence interval, 1.58-3.45), urinary complications (1.51; 1.21-1.90), readmission (1.44; 1.29-1.59), wound complications (1.31; 1.09-1.57), and respiratory complications (1.93; 1.21-3.07). CONCLUSION: Discharge to continued inpatient care following THA is associated with increased odds of postdischarge morbidity and unplanned readmission, after propensity score adjustment for predischarge characteristics. Additional research is needed on the impact of devoting resources toward facilitating discharge to home after THA. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28455181/Discharge_to_Inpatient_Facilities_After_Total_Hip_Arthroplasty_Is_Associated_With_Increased_Postdischarge_Morbidity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30280-2 DB - PRIME DP - Unbound Medicine ER -