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Patient expectation may be most predictive factor of discharge location after TJA
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The most important predictor for the final disposition after total joint arthroplasty was patients’ expectation of discharge destination, according to recently published study results.
Researchers retrospectively reviewed the medical records of 372 patients who underwent total joint arthoplasty (TJA) between January 1, 2012, and December 31, 2012, at a single institution. Patients who underwent total hip arthroplasty (THA) received single shot fascia iliaca block, and those who underwent total knee arthroplasty (TKA) received continuous femoral nerve block. After surgery, the patients began continuous physical therapy and occupational therapy (PT / OT) until the time of discharge.
Patients were discharged when they were medically stable, able to tolerate and void oral diets, had no surgical concerns or were functionally suitable for the discharge location determined by PT / OT, and when pain control was deemed adequate.
The researchers analyzed patient variables including age, sex, BMI, number of comorbidities, history of TJA, history of extended care facility (ECF) admission, level of pain, utilization of an assistive device, unilateral vs. bilateral procedure, home caregiver assistance, type of surgery (THA vs. TKA) and patient expectation of discharge location.
According to the researchers, 264 patients were discharged home, whereas 108 patients were discharged to an ECF. The mean lengths of hospital stay for patients discharged home and those discharged to an ECF were 2.6 days and 3.5 days, respectively. Surgery type did not significantly predict discharge location, according to the researchers.
Results showed for both univariable and multivariable analysis, only age, home assistance and patient expectation of discharge location were statistically significant variables. Among these variables, however, patient expectation of discharge location was found to be the most important predictor, the researchers reported.
During hospitalization, 27 patients developed minor postoperative complications. Patients were at high risk for a blood transfusion if discharged to an ECF. Overall, discharge to an ECF and complication development were significantly correlated, according to the researchers. ‒ by Monica Jaramillo
Disclosures: Halawi reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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