Factors Affecting Discharge Disposition After Primary Simultaneous Bilateral Joint Arthroplasty

Area of Science:

• Orthopedic Surgery
• Rehabilitation Medicine
• Health Services Research

Background:

• Discharge destination after total joint arthroplasty (TJA) significantly impacts post-operative costs, clinical outcomes, and readmission rates.
• Limited research exists on factors influencing discharge destination for patients undergoing primary simultaneous bilateral total joint arthroplasty (PSBTHA or PSBTKA).

Purpose of the Study:

• To identify clinical and social factors associated with discharge to home versus a rehabilitation facility (RF) for patients undergoing primary simultaneous bilateral total hip arthroplasty (PSBTHA) or primary simultaneous bilateral total knee arthroplasty (PSBTKA).

Main Methods:

• Retrospective cohort study of patients undergoing PSBTHA or PSBTKA between February 2016 and March 2018.
• Data collected included social and clinical demographics.
• Multiple regression analysis was used to determine significant factors related to discharge plans.

Main Results:

• For PSBTHA, a posterolateral surgical approach was the only significant factor predicting discharge to an RF.
• For PSBTKA, increased body mass index (BMI), older age, and the use of an adductor-only nerve block were associated with discharge to an RF.
• Discharge to home was observed in 60.5% of PSBTHA patients and 22% of PSBTKA patients.

Conclusions:

• Findings highlight key variables influencing discharge destination after PSBTHA and PSBTKA.
• This information aids in safe pre-operative discharge planning and appropriate patient care level assignment.
• Future research should explore surgeon experience, surgical technique, and pre-operative physical therapy discussions.