Home health services may increase costs without lowering complications after TKA
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CHICAGO — Use of home health services after total knee arthroplasty may increase costs without decreasing the rates of complications, ED visits or readmissions, according to results presented here.
“While home health nursing care may benefit specific patients, we would caution against liberal prescribing of home health,” Robert A. Burnett III, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Using the PearlDiver database from 2010 to 2018, Burnett and colleagues compared demographics, length of stay, ED visits, readmissions and medical surgery complications within 90-days, as well as episode of care costs within 90-days, among patients older than 65 years who underwent primary unilateral TKA and were discharged with either home health care or under self-care.
“At 3 months, the rate of medical complications was comparable amongst groups,” Burnett said. “Similarly, when we looked at surgical variables, including manipulations, fractures and [irrigation and debridement] procedures, these were similar at 3 months.”
Burnett noted no significant differences between the home health group and the home under self-care group with regard to complications. Patients in the home health care group presented to the ED at a higher rate at 2 weeks and 3 months postoperatively and had higher readmissions at 2 weeks compared with the self-care group, according to Burnett.
“Finally, looking at costs, we found the home health group had a higher total episode of care costs than the home under self-care group,” Burnett said. “This was by about $2,000, [with] $1,500 from direct costs of home health nursing and the other costs were indirectly related to increased emergency room visits and readmissions.”
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Mestyanek C, et al. Paper 513. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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