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Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort.
J Arthroplasty. 2018 05; 33(5):1343-1347.JA

Abstract

BACKGROUND

The benefits of discharge to a skilled nursing facility (SNF) in Medicare-eligible patients after total joint arthroplasty (TJA) have recently been scrutinized. The purpose of this study was to determine short-term complication and readmission rates for SNF versus home discharge in patients eligible for Medicare and SNF discharge.

METHODS

Patients who underwent TJA between 2012 and 2013 were identified in the National Surgical Quality Improvement Project database. Patients over 65 years and who discharged at or after postoperative day 3, and thus SNF eligible by Medicare rule, were included. Patient demographics and comorbidities were compared in the 2 cohorts (home versus SNF), and subsequent univariate and multivariate analyses were used to determine risk factors for short-term complications.

RESULTS

We identified 34,610 Medicare- and SNF-eligible TJA patients; 54.8% discharged home. Patients with SNF discharge were older, had higher rates of comorbidities, and were more frequently American Society of Anesthesiologists class 3 or 4 (P < .001). Univariate analysis revealed that patients with SNF discharge had higher rates of any complication (7.9% vs. 4.7%, P < .001) and readmission (5.3% vs. 3.3%, P < .001). Multivariate regression analysis identified SNF discharge (adjusted odds ratio 1.9, 95% confidence interval 1.7-2.0) as an independent risk factor for a 30-day complication and readmission.

CONCLUSIONS

In a cohort of Medicare- and SNF-eligible patients, SNF discharge was the strongest predictor of 30-day complication after TJA. SNF discharge was also an independent predictor of readmission after TJA.

Authors+Show Affiliations

Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.Department of Orthopedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29429881

Citation

Owens, Jessell M., et al. "Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort." The Journal of Arthroplasty, vol. 33, no. 5, 2018, pp. 1343-1347.
Owens JM, Callaghan JJ, Duchman KR, et al. Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort. J Arthroplasty. 2018;33(5):1343-1347.
Owens, J. M., Callaghan, J. J., Duchman, K. R., Bedard, N. A., & Otero, J. E. (2018). Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort. The Journal of Arthroplasty, 33(5), 1343-1347. https://doi.org/10.1016/j.arth.2018.01.002
Owens JM, et al. Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort. J Arthroplasty. 2018;33(5):1343-1347. PubMed PMID: 29429881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility-Eligible Patient Cohort. AU - Owens,Jessell M, AU - Callaghan,John J, AU - Duchman,Kyle R, AU - Bedard,Nicholas A, AU - Otero,Jesse E, Y1 - 2018/01/11/ PY - 2017/10/30/received PY - 2018/01/02/revised PY - 2018/01/04/accepted PY - 2018/2/13/pubmed PY - 2019/2/13/medline PY - 2018/2/13/entrez KW - Medicare eligible KW - readmission KW - skilled nursing facility KW - total hip arthroplasty KW - total joint arthroplasty KW - total knee arthroplasty SP - 1343 EP - 1347 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 33 IS - 5 N2 - BACKGROUND: The benefits of discharge to a skilled nursing facility (SNF) in Medicare-eligible patients after total joint arthroplasty (TJA) have recently been scrutinized. The purpose of this study was to determine short-term complication and readmission rates for SNF versus home discharge in patients eligible for Medicare and SNF discharge. METHODS: Patients who underwent TJA between 2012 and 2013 were identified in the National Surgical Quality Improvement Project database. Patients over 65 years and who discharged at or after postoperative day 3, and thus SNF eligible by Medicare rule, were included. Patient demographics and comorbidities were compared in the 2 cohorts (home versus SNF), and subsequent univariate and multivariate analyses were used to determine risk factors for short-term complications. RESULTS: We identified 34,610 Medicare- and SNF-eligible TJA patients; 54.8% discharged home. Patients with SNF discharge were older, had higher rates of comorbidities, and were more frequently American Society of Anesthesiologists class 3 or 4 (P < .001). Univariate analysis revealed that patients with SNF discharge had higher rates of any complication (7.9% vs. 4.7%, P < .001) and readmission (5.3% vs. 3.3%, P < .001). Multivariate regression analysis identified SNF discharge (adjusted odds ratio 1.9, 95% confidence interval 1.7-2.0) as an independent risk factor for a 30-day complication and readmission. CONCLUSIONS: In a cohort of Medicare- and SNF-eligible patients, SNF discharge was the strongest predictor of 30-day complication after TJA. SNF discharge was also an independent predictor of readmission after TJA. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/29429881/Short_term_Morbidity_and_Readmissions_Increase_With_Skilled_Nursing_Facility_Discharge_After_Total_Joint_Arthroplasty_in_a_Medicare_Eligible_and_Skilled_Nursing_Facility_Eligible_Patient_Cohort_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(18)30010-X DB - PRIME DP - Unbound Medicine ER -