A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty

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Abstract

Background

Total joint arthroplasty (TJA) represents the single largest procedural cost for the Centers for Medicare & Medicaid Services. Discharge to a skilled nursing facility (SNF) remains a primary driver of post-acute care costs. The COVID-19 pandemic led to a decrease in number of discharges to SNFs. Examining preoperative patient characteristics of those who are still admitted to SNFs, despite cultural shifts, may help providers identify patients still at high risk for SNF discharge.

Methods

This retrospective study included patients who had elective total hip arthroplasty or total knee arthroplasty from January through December 2022 at a high-volume orthopaedic institute. Preoperative patient-reported outcome scores, demographics, and clinical characteristics were collected from patient charts and compared between patients who were discharged home vs SNF. Multivariate logistic regression analyses were used to determine potential predictors for discharge to SNF.

Results

In the total sample ( N = 2795), 96.4% of patients were discharged home, and 3.6% were discharged to a SNF. Medicare insurance was associated with being discharged to a SNF ( P < .05), while having commercial insurance was associated with being discharged home ( P < .05). Being older, having longer procedure length, longer hospital length of stay, and a lower preoperative Patient-Reported Outcomes Measurement Information System (PROMIS 10) score were significant predictors of discharge to SNF ( P < .05).

Conclusions

This was the first study to identify PROMIS 10 score as a potential predictor of discharge to a SNF after TJA. Findings from this study may help providers redefine contemporary predictors of SNF admission following TJA.

Related collections

Most cited references 19

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Minimal important change (MIC): a conceptual clarification and systematic review of MIC estimates of PROMIS measures

Caroline Terwee, John Peipert, Robert Chapman … (2021)

We define the minimal important change (MIC) as a threshold for a minimal within-person change over time above which patients perceive themselves importantly changed. There is a lot of confusion about the concept of MIC, particularly about the concepts of minimal important change and minimal detectable change, which questions the validity of published MIC values. The aims of this study were: (1) to clarify the concept of MIC and how to use it; (2) to provide practical guidance for estimating methodologically sound MIC values; and (3) to improve the applicability of PROMIS by summarizing the available evidence on plausible PROMIS MIC values. We discuss the concept of MIC and how to use it and provide practical guidance for estimating MIC values. In addition, we performed a systematic review in PubMed on MIC values of any PROMIS measure from studies using recommended approaches. A total of 50 studies estimated the MIC of a PROMIS measure, of which 19 studies used less appropriate methods. MIC values of the remaining 31 studies ranged from 0.1 to 12.7 T-score points. We recommend to use the predictive modeling method, possibly supplemented with the vignette-based method, in future MIC studies. We consider a MIC value of 2–6 T-score points for PROMIS measures reasonable to assume at this point. For surgical interventions a higher MIC value might be appropriate. We recommend more high-quality studies estimating MIC values for PROMIS. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02925-y.

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Discharge Destination After Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes, Placement Risk Factors, and Recent Trends

Aakash Keswani, Michael Tasi, Adam Fields … (2016)

This study aimed to compare risk of postdischarge adverse events in elective total joint arthroplasty (TJA) patients by discharge destination, identify risk factors for inpatient discharge placement and postdischarge adverse events, and stratify TJA patients based on these risk factors to identify the most appropriate discharge destination.

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What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions?

Man Hung, Charles Saltzman, Richard Kendall … (2018)

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Author and article information

Contributors

Swaroopa Vaidya

Journal

Journal ID (nlm-ta): Arthroplast Today

Journal ID (iso-abbrev): Arthroplast Today

Title: Arthroplasty Today

Publisher: Elsevier

ISSN (Electronic): 2352-3441

Publication date PMC-release: 14 December 2024

Publication date Collection: February 2025

Publication date (Electronic): 14 December 2024

Volume: 31

Electronic Location Identifier: 101592

Affiliations

[a ]Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA

[b ]Hartford HealthCare Research Program, Hartford Healthcare, Hartford, CT, USA

[c ]Frank H. Netter School of Medicine at Quinnipiac University, North Haven, USA

[d ]Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Meriden, CT, USA

Author notes

[∗ ]Corresponding author. Swaroopa Vaidya, MS, Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA. Tel.: +1 475 210 4287. swaroopa.vaidya@ 123456hhchealth.org

Article

Publisher Item ID: S2352-3441(24)00277-2 Publisher ID: 101592

DOI: 10.1016/j.artd.2024.101592

PMC ID: 11715114

SO-VID: 7450d2ad-ab94-4c95-ae53-a93bec5826e0

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

History

Date received : 1 August 2024

Date revision received : 5 November 2024

Date accepted : 13 November 2024

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