Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends

Keswani, Aakash; Tasi, Michael C.; Fields, Adam C.; Lovy, Andrew J.; Moucha, Calin S.; Bozic, Kevin J.

doi:10.1016/j.arth.2015.11.044

Cited by 227 publications

(170 citation statements)

References 28 publications

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“…We attempted to control for this using a weighted propensity score model, but this can only control for observed variables. Additionally, recent evidence has shown that discharge to postacute care facilities is associated with numerous complications, including unplanned readmission, after hospital discharge [12]. These associations may have confounded some of our results.…”

Section: Discussioncontrasting

confidence: 46%

The Frank Stinchfield Award

Schairer

Lane

Halsey

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA. Questions/purposes (1) What are the differences in inhospital and 30-day postoperative clinical outcomes for THA performed for femoral neck fracture versus OA? (2) Is a patient's fracture status, that is whether or not a patient has a femoral neck fracture, associated with differences in in-hospital and 30-day postoperative clinical outcomes after THA?Methods The National Surgical Quality Improvement Program (NSQIP) database, which contains outcomes for surgical patients up to 30 days after discharge, was used to identify patients undergoing THA for OA and femoral neck fracture. OA and fracture cohorts were matched one-to-one using propensity scores based on age, gender, American Society of Anesthesiologists grade, and medical comorbidities. Propensity scores represented the conditional probabilities for each patient having a femoral neck fracture based on their individual characteristics, excluding their actual fracture status. Outcomes of interest included operative time, length of stay (LOS), complications, transfusion, discharge destination, and readmission. There were 42,692 patients identified (41,739 OA; 953 femoral neck fractures) with 953 patients in each group for the matched analysis.One of the authors (JML) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Amgen, Inc (Thousand Oaks, CA, USA) in the amount of less than USD 10,000; Eli Lilly and Company (Indianapolis, IN, USA) in the amount of less than USD 10,000; Graftys (Aix-en-Provence, France) in the amount of less than USD 10,000; Kuros Biosurgery AG (Zürich, Switzerland) in the amount of less than USD 10,000; Bone Therapeutics (Brussels, Belgium) in the amount of less than USD 10,000; and Merck & Co, Inc (Kenilworth, NJ, USA) in the amount of USD 100,001 to USD 1,000,000. One of the authors (DEP) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Mako Surgical Corp (Davie, FL, USA) in the amount of less than USD 10,001 to USD 100,000; and Stryker Corporation (Kalamazoo, MI, USA) in the amount of less than USD 10,000. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request.Each ...

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Section: Discussioncontrasting

confidence: 46%

The Frank Stinchfield Award

Schairer

Lane

Halsey

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Beside reducing costs, rehabilitation at home is more effective and safe for people after TJA. 67,68 Our studies provide tools for risk assessment and discharge planning. Although the recent literature recommends the use of the Risk Assessment and Prediction Tool (RAPT) together with medical factors and body mass index, 68,69 we concluded that simple performance-based measures are of additional value to these more conventional measures and tools for predicting recovery (Chapter 3) and hence optimal discharge timing and destination.…”

Section: Effectiveness On Inpatient Postoperative Physical Functioningmentioning

confidence: 99%

“…67,68 Our studies provide tools for risk assessment and discharge planning. Although the recent literature recommends the use of the Risk Assessment and Prediction Tool (RAPT) together with medical factors and body mass index, 68,69 we concluded that simple performance-based measures are of additional value to these more conventional measures and tools for predicting recovery (Chapter 3) and hence optimal discharge timing and destination. Shorter LOS and less use of inpatient rehabilitation will reduce costs; total hospital costs for THA are about 10,000 euro in the Netherlands 70 and 1 day of inpatient rehabilitation costs about 250 euro and a 14-day stay about 3000 euro.…”

Section: Effectiveness On Inpatient Postoperative Physical Functioningmentioning

confidence: 99%

“…Most care pathways and physical therapy interventions seem to be based on one-size-fits-all principle: on average, all patients receive the same intervention. The randomized controlled trials (RCTs) included in systematic reviews of the effectiveness of perioperative exercises typically used standardized exercises, 25,68,69 even though older people often have multiple diseases and geriatric symptoms that affect their physical abilities. A more tailored functional exercise program may fit the individual needs of elder people better.…”

Section: Osteoarthritis and Total Hip Arthroplastymentioning

confidence: 99%

“…Although exercise programs have an important role in optimizing preoperative and postoperative functioning, their effectiveness is still limited. [24][25][26]68,69 Given the different barriers elderly individuals face in their recovery after THA, there are several gaps between the needs of elderly patients and current care pathways and research.…”

Section: Osteoarthritis and Total Hip Arthroplastymentioning

confidence: 99%

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