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Discharge to nursing or inpatient rehabilitation facilities linked with risk of adverse events after TJA
A study 106,360 patients who underwent either total hip or total knee arthroplasty between 2011 and 2013 showed the risk of postdischarge adverse events following total joint arthroplasty increased with discharge of patients to a skilled nursing facility or an inpatient rehabilitation facility compared to home.
Results showed 70% of patients in the study were discharged home compared to 19% of patients who were discharged to a skilled nursing facility (SNF) and 11% of patients who went to an inpatient rehabilitation facility (IRF). Patients discharged to SNFs and IRFs had higher rates of postdischarge adverse events, according to bivariate analysis results. Similarly, a multivariate analysis that controlled for patient characteristics, comorbidities and the incidence of complications pre-discharge showed patients discharged to SNFs and IRFs had higher postdischarge severe adverse events and unplanned readmissions.
Researchers found home discharge minimized the rate of severe 30-day adverse events after discharge and for unplanned 30-day readmissions after they stratified patients by strongest independent risk factors for adverse outcomes after discharge. Predictors of non-home discharge included incidence of severe adverse events pre-discharge, female gender, functional status, BMI greater than 40, smoking, diabetes, pulmonary disease, hypertension and American Society of Anesthesiologists classes 3 and 4, according to results from a multivariate analysis. – by Casey Tingle
Disclosures: Keswani reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.