Abstract
Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.
Highlights
In the United States, total joint arthroplasty (TJA) demand has increased due to the aging population and rising obesity rates [1]
Gender, pre-operative weight, body mass index (BMI), American Society of Anesthesiologists (ASA) score [22], diabetes status, smoking status, intravenous (IV) drug use, depression, primary language, surgery type, previous surgery, race/ethnicity, insurance and employment status were extracted from the pre-operative anesthesia note; all were pre-operatively self-reported by the patient with the exception of BMI, which was measured by nursing in the clinic
There was a significant difference in age (p = 0.004), employment (p = 0.005), exercise/active status (p = 0.03), expectation of discharge to an skilled nursing facilities (SNF) (p ≤ 0.0001), ASA score (p = 0.0003), and length of stay in the hospital (p = 0.013) between patients living alone who were discharged to home versus
Summary
In the United States, total joint arthroplasty (TJA) demand has increased due to the aging population and rising obesity rates [1]. Patients discharged to home following TJA have lower associated costs, decreased rates of infection, increased patient satisfaction, reduced 30-day readmissions, and improved clinical outcomes [6,7,8,9,10,11]. Factors driving discharge destination include age, race/ethnicity, socioeconomic status (SES), and access to health care [12,13,14,15,16,17,18,19,20,21]. Living status has been shown to be a significant factor in discharge destination, with patients living alone being more likely to be discharged to an SNF [12].
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