Identifying Patients at Risk for a Facility Discharge Following Elective Total Joint Arthroplasty Using Preoperative...

Facility discharges following an elective, primary, total joint arthroplasty are infrequent but are associated with poor outcomes and significant cost. Therefore, investigating ways to identify patients most likely to be discharged to a facility could improve patient care, reduce costs, and potentially lead to strategies to mitigate these risks.

A total of 3,198 patients who underwent a total hip or knee arthroplasty between June 2021 and June 2023 were included in this study. Independent factors associated with a discharge to a facility were identified using logistic regressions, and receiver operator curve cut-point analysis was used to determine threshold values for these factors.

Facility discharge occurred 138 times (4.3%). A total of 12 factors were associated with a facility discharge. There were nine factors collected preoperatively, of which two were based on demographics and medical history (i.e., age and the Charlson Comorbidity Index) and seven were obtained from patient-reported outcome measures (i.e., the Risk Assessment and Prediction Tool score and individual question responses, the Patient-Reported Outcomes Measurement Information System T-scores for physical function and mental health, and the results of the Brief Resiliency Scale). There were three inpatient variables (i.e., ambulation distance, length of stay, and timed up-and-go results) also noted to be significantly associated with a facility discharge. Patients who had five preoperative factors, or eight factors overall, were most likely to be discharged to a facility.

The results of this study indicated that a patient's mental health, mobility, and support structure at home are the most influential factors associated with a facility discharge. Additionally, the results suggested that the patient-reported outcome measures provide a significant discriminatory ability to identify patients at risk for a facility discharge following a primary total joint arthroplasty.

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