Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors
Abstract Background Given the rising incidence of revision total joint replacement (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare post-discharge adverse events by discharge destination, identify risk factors for discharge placement, and stratify...
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| Veröffentlicht in: | The Journal of arthroplasty 2016 |
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| creator | Keswani, Aakash, BA Weiser, Mitchell C., MD Shin, John, BS Lovy, Andrew J., MD Moucha, Calin S., MD |
| description | Abstract Background Given the rising incidence of revision total joint replacement (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare post-discharge adverse events by discharge destination, identify risk factors for discharge placement, and stratify RJR patients based on these risk factors to identify the most appropriate discharge destination. Methods Patients that underwent revision total hip or knee replacement from 2011-2013 were identified in the ACS NSQIP database. Analysis of risk factors was assessed using preoperative and intraoperative variables. Results 9,973 RJR patients from 2011 to 2013 were included for analysis. The most common discharge destination included home (66%), skilled nursing facility (SNF) (23%), and inpatient rehabilitation facility (IRF) (11%). Bivariate analysis revealed higher rate of post-discharge 30-day severe adverse events (SAEs) (6.1% vs. 4.1%, p |
| doi_str_mv | 10.1016/j.arth.2016.02.053 |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier</sourceid><recordid>TN_cdi_elsevier_clinicalkeyesjournals_1_s2_0_S0883540316001996</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0883540316001996</els_id><sourcerecordid>1_s2_0_S0883540316001996</sourcerecordid><originalsourceid>FETCH-elsevier_clinicalkeyesjournals_1_s2_0_S08835403160019963</originalsourceid><addsrcrecordid>eNqlj8tOwzAQRb0AifL4AVb-gRg7aaKWBRseYg97a-RMqFM3U3mmlbLj03EkxA-wmrnSnTM6St07a5x13cNoIMvO1GU3tja2bS7Uym42TdWubXOlrplHa51r2_VKfb9EDjvIX6h7ZIkTSKRJwyCYdcZz5CUKCSQ9UpxEL_BMxwQs86OG0p0gzRxZ06CPxFL1f0g6SaADcun0upwEPGBB5Mh7PUAQynyrLgdIjHe_80Y9vb1-Pr9XWMI5YvYhxSkGSHuckUc65fKPvfNce-s_FrHFy3XFabvtmn8DfgDbOWnf</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors</title><source>ScienceDirect Journals (5 years ago - present)</source><creator>Keswani, Aakash, BA ; Weiser, Mitchell C., MD ; Shin, John, BS ; Lovy, Andrew J., MD ; Moucha, Calin S., MD</creator><creatorcontrib>Keswani, Aakash, BA ; Weiser, Mitchell C., MD ; Shin, John, BS ; Lovy, Andrew J., MD ; Moucha, Calin S., MD</creatorcontrib><description>Abstract Background Given the rising incidence of revision total joint replacement (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare post-discharge adverse events by discharge destination, identify risk factors for discharge placement, and stratify RJR patients based on these risk factors to identify the most appropriate discharge destination. Methods Patients that underwent revision total hip or knee replacement from 2011-2013 were identified in the ACS NSQIP database. Analysis of risk factors was assessed using preoperative and intraoperative variables. Results 9,973 RJR patients from 2011 to 2013 were included for analysis. The most common discharge destination included home (66%), skilled nursing facility (SNF) (23%), and inpatient rehabilitation facility (IRF) (11%). Bivariate analysis revealed higher rate of post-discharge 30-day severe adverse events (SAEs) (6.1% vs. 4.1%, p<0.001) and unplanned readmissions (9.3% vs. 6.1%, p<0.001) in non-home vs. home patients. In multivariate analysis, SNF and IRF patients were 1.30 and 1.51 times more likely to suffer an unplanned 30-day readmission relative to home patients (p≤0.01), respectively. After stratifying patients by number of significant risk factors and discharge destination, IRF patients consistently had significantly higher rates of unplanned 30-day readmission as compared to home patients (p≤0.05). Conclusion RJR patients who are discharged to SNF or IRF have significantly increased risk for unplanned readmissions as compared to patients discharged home. Across risk levels, home discharge destination (when feasible) is the optimal strategy compared to IRF, although the distinction between SNF and home is less clear.</description><identifier>ISSN: 0883-5403</identifier><identifier>DOI: 10.1016/j.arth.2016.02.053</identifier><language>eng</language><subject>Orthopedics</subject><ispartof>The Journal of arthroplasty, 2016</ispartof><rights>Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4022,27921,27922,27923</link.rule.ids></links><search><creatorcontrib>Keswani, Aakash, BA</creatorcontrib><creatorcontrib>Weiser, Mitchell C., MD</creatorcontrib><creatorcontrib>Shin, John, BS</creatorcontrib><creatorcontrib>Lovy, Andrew J., MD</creatorcontrib><creatorcontrib>Moucha, Calin S., MD</creatorcontrib><title>Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors</title><title>The Journal of arthroplasty</title><description>Abstract Background Given the rising incidence of revision total joint replacement (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare post-discharge adverse events by discharge destination, identify risk factors for discharge placement, and stratify RJR patients based on these risk factors to identify the most appropriate discharge destination. Methods Patients that underwent revision total hip or knee replacement from 2011-2013 were identified in the ACS NSQIP database. Analysis of risk factors was assessed using preoperative and intraoperative variables. Results 9,973 RJR patients from 2011 to 2013 were included for analysis. The most common discharge destination included home (66%), skilled nursing facility (SNF) (23%), and inpatient rehabilitation facility (IRF) (11%). Bivariate analysis revealed higher rate of post-discharge 30-day severe adverse events (SAEs) (6.1% vs. 4.1%, p<0.001) and unplanned readmissions (9.3% vs. 6.1%, p<0.001) in non-home vs. home patients. In multivariate analysis, SNF and IRF patients were 1.30 and 1.51 times more likely to suffer an unplanned 30-day readmission relative to home patients (p≤0.01), respectively. After stratifying patients by number of significant risk factors and discharge destination, IRF patients consistently had significantly higher rates of unplanned 30-day readmission as compared to home patients (p≤0.05). Conclusion RJR patients who are discharged to SNF or IRF have significantly increased risk for unplanned readmissions as compared to patients discharged home. Across risk levels, home discharge destination (when feasible) is the optimal strategy compared to IRF, although the distinction between SNF and home is less clear.</description><subject>Orthopedics</subject><issn>0883-5403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqlj8tOwzAQRb0AifL4AVb-gRg7aaKWBRseYg97a-RMqFM3U3mmlbLj03EkxA-wmrnSnTM6St07a5x13cNoIMvO1GU3tja2bS7Uym42TdWubXOlrplHa51r2_VKfb9EDjvIX6h7ZIkTSKRJwyCYdcZz5CUKCSQ9UpxEL_BMxwQs86OG0p0gzRxZ06CPxFL1f0g6SaADcun0upwEPGBB5Mh7PUAQynyrLgdIjHe_80Y9vb1-Pr9XWMI5YvYhxSkGSHuckUc65fKPvfNce-s_FrHFy3XFabvtmn8DfgDbOWnf</recordid><startdate>2016</startdate><enddate>2016</enddate><creator>Keswani, Aakash, BA</creator><creator>Weiser, Mitchell C., MD</creator><creator>Shin, John, BS</creator><creator>Lovy, Andrew J., MD</creator><creator>Moucha, Calin S., MD</creator><scope/></search><sort><creationdate>2016</creationdate><title>Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors</title><author>Keswani, Aakash, BA ; Weiser, Mitchell C., MD ; Shin, John, BS ; Lovy, Andrew J., MD ; Moucha, Calin S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-elsevier_clinicalkeyesjournals_1_s2_0_S08835403160019963</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keswani, Aakash, BA</creatorcontrib><creatorcontrib>Weiser, Mitchell C., MD</creatorcontrib><creatorcontrib>Shin, John, BS</creatorcontrib><creatorcontrib>Lovy, Andrew J., MD</creatorcontrib><creatorcontrib>Moucha, Calin S., MD</creatorcontrib><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keswani, Aakash, BA</au><au>Weiser, Mitchell C., MD</au><au>Shin, John, BS</au><au>Lovy, Andrew J., MD</au><au>Moucha, Calin S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors</atitle><jtitle>The Journal of arthroplasty</jtitle><date>2016</date><risdate>2016</risdate><issn>0883-5403</issn><abstract>Abstract Background Given the rising incidence of revision total joint replacement (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare post-discharge adverse events by discharge destination, identify risk factors for discharge placement, and stratify RJR patients based on these risk factors to identify the most appropriate discharge destination. Methods Patients that underwent revision total hip or knee replacement from 2011-2013 were identified in the ACS NSQIP database. Analysis of risk factors was assessed using preoperative and intraoperative variables. Results 9,973 RJR patients from 2011 to 2013 were included for analysis. The most common discharge destination included home (66%), skilled nursing facility (SNF) (23%), and inpatient rehabilitation facility (IRF) (11%). Bivariate analysis revealed higher rate of post-discharge 30-day severe adverse events (SAEs) (6.1% vs. 4.1%, p<0.001) and unplanned readmissions (9.3% vs. 6.1%, p<0.001) in non-home vs. home patients. In multivariate analysis, SNF and IRF patients were 1.30 and 1.51 times more likely to suffer an unplanned 30-day readmission relative to home patients (p≤0.01), respectively. After stratifying patients by number of significant risk factors and discharge destination, IRF patients consistently had significantly higher rates of unplanned 30-day readmission as compared to home patients (p≤0.05). Conclusion RJR patients who are discharged to SNF or IRF have significantly increased risk for unplanned readmissions as compared to patients discharged home. Across risk levels, home discharge destination (when feasible) is the optimal strategy compared to IRF, although the distinction between SNF and home is less clear.</abstract><doi>10.1016/j.arth.2016.02.053</doi></addata></record> |
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| subjects | Orthopedics |
| title | Discharge destination after revision total joint arthroplasty: an analysis of post-discharge outcomes and placement risk factors |
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