Intrinsic Patient Factors Predictive of Inpatient Rehabilitation Facility Discharge Following Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

Abstract

Background Total Knee Arthroplasty (TKA) reduces pain and improves function in those suffering from severe osteoarthritis. A significant cost of TKA is post-acute care, however, current evidence suggests that discharge to an Inpatient Rehabilitation Facility (IRF) has inferior outcomes to home discharge, with no greater benefit in physical function. Only individual studies have investigated TKA patient characteristics predictive of discharge destination, therefore, the aim is to systematically review the literature and meta-analyse intrinsic patient factors predictive of IRF discharge. If predictive factors are known, then early discharge planning and intervention strategies could be implemented. Methods Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to October 2019 for articles investigating pre-operative intrinsic patient factors predictive of IRF discharge. For assessing the methodological quality of included studies, the Quality In Prognosis Studies (QUIPS) tool was used. Statistical analysis and graphical reporting were conducted in R statistical software. To assess the effect of predictors of discharge destination, odds ratios with the corresponding 95%CI were extracted from the results of univariate and multivariable analyses. Results A total of 9 articles published between 2011 to 2018 with 218,151 TKA patients were included. Of the 13 intrinsic patient factors reported, 6 met the criteria for synthesised review: age, obesity, comorbidity, gender, SF-12/VR-12 survey, and smoking. Due to the heterogeneity of statistical analysis and reporting 2 variables could undergo meta-analysis, gender and smoking. Female gender increased the likelihood of IRF discharge by 1.78 (OR=1.78; 95%CI=1.43–2.20; I2=33.3%), however, the relationship between smoking status and discharge destination was less certain (OR=0.80; 95%CI=0.42–1.50; I2=68.5%). Conclusion Female gender was shown to be predictive of IRF discharge after total knee arthroplasty. There was also a trend for those of older age, increased comorbidity or the severely obese to have an increased likelihood of IRF discharge. This systematic review and meta-analysis suggests that the heterogeneity of existing literature is inadequate to develop a predictive model for intrinsic patient factors associated with IRF discharge. Further, high quality studies of prospective design on predictive factors are warranted, to enable early discharge planning and optimise resource consumption on post-acute care following TKA.