Does discharge disposition after primary total joint arthroplasty affect readmission rates?

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient Outcomes

Background:

• Total joint arthroplasty (TJA) is a common procedure with significant healthcare resource utilization.
• Understanding factors influencing 90-day hospital readmissions after TJA is critical for improving patient care and reducing costs.

Purpose of the Study:

• To investigate the association between discharge disposition (skilled nursing facility vs. home) and 90-day readmission rates following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Main Methods:

• Retrospective review of 9150 patients undergoing primary THA or TKA between April 2001 and December 2004.
• Exclusion of patients with American Society of Anesthesiologists (ASA) scores of 3 or greater or perioperative complications.
• Statistical analysis correlating discharge to a skilled nursing facility (SNF) versus home with 90-day readmission rates, adjusting for demographic and clinical factors.

Main Results:

• Patients discharged to SNFs had significantly higher odds of 90-day hospital readmission compared to those discharged home.
• For THA patients, the odds ratio (OR) for readmission was 1.9 (95% CI, 1.2-3.2; P = .008).
• For TKA patients, the OR for readmission was 1.6 (95% CI, 1.1-2.4; P = .01).

Conclusions:

• Discharge to an SNF after primary TJA is an independent risk factor for 90-day hospital readmission in otherwise healthy patients.
• Enhanced post-discharge surveillance and targeted interventions for TJA patients discharged to SNFs are warranted to mitigate readmission risks.