The Effect of Comorbidities on Discharge Disposition and Readmission for Total Joint Arthroplasty Patients

Sikora‐Klak, Jakub; Zarling, Bradley J.; Bergum, Christopher; Flynn, Jeffrey C.; Markel, David C.

doi:10.1016/j.arth.2016.11.035

Cited by 25 publications

(24 citation statements)

References 20 publications

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“…Some of the variables that have been shown to affect the outcome after total joint replacement include social and demographic characteristics, medical comorbidities, and surgical technique [3][4][5][6][7]. Areas of continued active research include the effect of intrinsic factors such as obesity [8][9][10], cardiovascular disease [11,12], mental health disorders [13•, 14-17•, 18•, 19], hepatic disease [20, 21•, 22, 23•, 24], nutritional deficiencies [25-29•, 30], bone metabolic disease [31][32][33][34][35][36][37], and diabetes mellitus [38•, 39, 40], as well as external factors such as nicotine use [41,42], recent corticosteroid injections [43][44][45][46][47], and discharge disposition [48,49]. The goal of this article is to review the most recent literature, published within the last 3 years, regarding a selection of patient-specific factors that may influence This article is part of the Topical Collection on Quality and Cost Control in TJA outcomes following total joint arthroplasty.…”

Section: Introductionmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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Purpose of Review It is well established that certain patientspecific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. Recent Findings Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Summary Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.

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Section: Introductionmentioning

confidence: 99%

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Schwartz

Lange

2017

Curr Rev Musculoskelet Med

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“…Being of female gender had an increased likelihood of IRF discharge of 1.78 times than those of male gender (OR = 1.78; 95% CI = 1.43-2.20) ( Figure 2). The association between age and discharge destination was reported in 6 studies [20,22,23,24,26,27]. Older age was predictive of IRF discharge in all included studies, with the greatest effect for those aged 75 years and older (Figure 3).…”

Section: Demographic Factorsmentioning

confidence: 93%

“…A total of 9 articles published between 2011 to 2018, with 218,151 TKA patients, were included in this review [19][20][21][22][23][24][25][26][27]. Of those, 4 articles [22,23,24,27] met the criteria to undergo meta-analysis.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

“…The patient factor gender was able to undergo meta-analysis in 4 studies [22,23,24,27] to provide results of a combined effect on predictability of discharge destination. Being of female gender had an increased likelihood of IRF discharge of 1.78 times than those of male gender (OR = 1.78; 95% CI = 1.43-2.20) ( Figure 2).…”

Section: Demographic Factorsmentioning

confidence: 99%

“…Smoking status (non-smoker or currently smoking) was reported on in 3 studies and was included in meta-analysis [22,23,27]. Smoking showed an overall decreased likelihood of IRF discharge (OR = 0.80; 95% CI 0.42-1.50), however, heterogeneity of the studies was moderate (I 2 = 68.5%) ( Figure 6).…”

Section: Behavioural Factorsmentioning

confidence: 99%

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

Sattler

Hing

Rathbone

et al. 2020

Preprint

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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.

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Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty

Nanri

Shibuya

Fukushima

et al. 2021

PM&R

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Introduction: Many studies have examined nutritional status and deteriorated postoperative outcomes in patients undergoing total hip arthroplasty. However, few studies have focused on nutritional status and postoperative mobility. Objective: To investigate the impact of preoperative nutritional status on mobility after total hip arthroplasty. Design: Retrospective single-institution cohort study. Setting: Orthopedic inpatient rehabilitation center. Participants: A total of 503 patients who underwent unilateral primary total hip arthroplasty from 2015 through 2019 were included. Methods: Data were collected on patient demographics, comorbidities, preoperative nutritional status, and quadriceps strength. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score. Interventions: Not applicable. Main Outcome Measure: The primary outcome was postoperative mobility defined as the number of days from surgery to starting to walk independently. Results: Among 503 patients undergoing total hip arthroplasty, 18.9% were classified as malnourished. Patients with malnutrition had a one-day delay in achieving mobilization compared with patients with normal nutrition (6 vs. 5 days, P = .006). According to the Kaplan-Meier curves, patients with malnutrition had a significant delay in mobilization compared with those with normal nutrition (P < .001). All three Cox proportional hazards regression models showed that preoperative malnutrition was associated with a higher risk of delayed mobilization (hazard ratios 0.70-0.74). Conclusions: Preoperative malnutrition as assessed by the CONUT is a significant risk factor for delayed recovery of mobilization after total hip arthroplasty.

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The Effect of Comorbidities on Discharge Disposition and Readmission for Total Joint Arthroplasty Patients

Cited by 25 publications

References 20 publications

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature

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

Preoperative malnutrition is a risk factor for delayed recovery of mobilization after total hip arthroplasty

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