Short-term Morbidity and Readmissions Increase With Skilled Nursing Facility Discharge After Total Joint Arthroplasty in a Medicare-Eligible and Skilled Nursing Facility–Eligible Patient Cohort

Abstract

BackgroundThe benefits of discharge to a skilled nursing facility (SNF) in Medicare-eligible patients after total joint arthroplasty (TJA) have recently been scrutinized. The purpose of this study was to determine short-term complication and readmission rates for SNF versus home discharge in patients eligible for Medicare and SNF discharge. MethodsPatients who underwent TJA between 2012 and 2013 were identified in the National Surgical Quality Improvement Project database. Patients over 65 years and who discharged at or after postoperative day 3, and thus SNF eligible by Medicare rule, were included. Patient demographics and comorbidities were compared in the 2 cohorts (home versus SNF), and subsequent univariate and multivariate analyses were used to determine risk factors for short-term complications. ResultsWe identified 34,610 Medicare- and SNF-eligible TJA patients; 54.8% discharged home. Patients with SNF discharge were older, had higher rates of comorbidities, and were more frequently American Society of Anesthesiologists class 3 or 4 (P < .001). Univariate analysis revealed that patients with SNF discharge had higher rates of any complication (7.9% vs. 4.7%, P < .001) and readmission (5.3% vs. 3.3%, P < .001). Multivariate regression analysis identified SNF discharge (adjusted odds ratio 1.9, 95% confidence interval 1.7-2.0) as an independent risk factor for a 30-day complication and readmission. ConclusionsIn a cohort of Medicare- and SNF-eligible patients, SNF discharge was the strongest predictor of 30-day complication after TJA. SNF discharge was also an independent predictor of readmission after TJA.