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Several medical comorbidities linked with discharge to nursing facility after THR
Identifying a care partner to help during recovery will increase the patient's chances at being sent home.
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DALLAS — Patients with several medical comorbidities who were living alone prior to total hip replacement were associated with discharge to a skilled nursing facility following surgery compared with home discharge, according to results presented at the American Association of Hip and Knee Surgeons Annual Meeting.
“There are data showing that patients who are discharged to home do as well from a pain improvement and functional improvement as patients who are discharged to a skilled nursing facility, and there is a lower rate of readmissions from home and a lower rate of complications,” David C. Ayers, MD, Arthur Pappas professor and chair of the Department of Orthopedics at the University of Massachusetts Medical School, told Orthopedics Today.
Discharge home vs SNF
In a cohort of 6,800 primary total hip replacements, Ayers and his colleagues identified preoperative demographic, medical, musculoskeletal and emotional comorbidities, pre-total hip replacement pain and function, global function and discharge status.
Results showed 70% of patients were discharged directly to home following total hip replacement. Researchers noted patients discharged to a skilled nursing facility (SNF) were older, more likely to have primary Medicare insurance and had poorer physical and emotional health. Compared with men and patients with no medical comorbidities, researchers found women and patients with two or more medical comorbidities were twice as likely to be discharged to a SNF. Patients were more likely to be discharged to a SNF if they were living alone compared with living with another adult.
“By identifying these people preoperatively, it gives orthopedic surgeons the ability to help intervene in order to assist these patients in a discharge to home, so they do not have to have the higher risk of readmissions and complications by going to the SNF,” Ayers said.
He added patients who were discharged home experienced equal pain relief and functional improvement as patients who were discharged to a SNF.
“There is no advantage in going to a SNF or going home with regard to the pain relief and the functional improvement of your joint replacement,” Ayers said. “However, there is an advantage in going home in terms of avoiding readmissions and a lower rate of complications.”
Additional support
As patients who are discharged to a SNF typically have lower social support systems, Ayers noted finding a care partner, whether it is a family member, friend or neighbor, who will provide additional support during recovery, is the key to sending a patient home instead to a SNF.
“By identifying a care partner who will come to the preoperative education class with them, will go to physical therapy in the hospital on the day of their discharge with them, will drive them home and will help them for the first 3 [days] to 5 days once they get home—this increases the likelihood the patients are going to go home and decreases the social reasons why they might previously have been discharged to a SNF,” Ayers said. – by Casey Tingle
- Reference:
- Ayers DC, et al. Paper #11. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 10-13, 2016; Dallas.
- For more information:
- David C. Ayers, MD, can be reached at University of Massachusetts Memorial Medical Center, 119 Belmont St., Worcester, MA 01605; email: kathleen.orell@umassmemorial.org.
Disclosure: Ayers reports no relevant financial disclosures.