Number of Stairs at Home Does Not Influence Discharge Disposition following Elective Total Hip Arthroplasty

Abstract

Background Pragmatic challenges of the patient’s home environment, specifically the number of stairs (NOS) required to enter or navigate a patient’s home may influence discharge destination (DD) and length of stay (LOS) following primary Total Hip Arthroplasty (THA). Questions/purposes This study investigates whether the NOS at home predicts discharge to a post-acute-care-facility (PACF) following THA. Methods 548 consecutive THA patients at a single urban arthroplasty center between 2011-2014 were reviewed. Patient factors including age, sex, BMI, length of stay, operative time, Anesthesia Score Assessment (ASA), the Risk-Assessment-and-Prediction-Tool (RAPT) and NOS stairs were analyzed. Logistic regression was performed to identify predictors for disposition to PACF. Groups were cohorted by number of stairs, and incidence of PACF discharge was determined. Results 238 (43.4%) patients were discharged to PACF. The NOS at home had no impact on discharge to PACF (OR 1.02, 95% CI .993-1.04, p=0.209). Older age (OR 1.09, 95% 1.07-1.10, p<0.0001), LOS (OR 1.23, 95% 1.08-1.39, p=0.001), higher ASA (OR 1.74, 95% 1.19-2.53, p=0.004), and lower RAPT score (OR 0.0.865, 95% 0.781-0.958, p=0.005) were significant predictors for disposition to PACF (p<0.005). Female sex was protective in discharge to PACF (OR 0.391, 95% 0.260-0.587, p<0.0001). The incidence of PACF discharge was similar between groups of unavoidable stairs at home. Conclusion The NOS at home did not influence discharge destination following THA. This retrospective study helps discharge planning and in setting expectations for patients undergoing THA by supporting a home discharge in the setting of unavoidable stairs.