A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty
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 dis...
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Elsevier
2025-02-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344124002772 |
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| author | Swaroopa Vaidya, MS Gregory Panza, PhD Jake Laverdiere, BS Dianne Vye, MSN, RN, ONC Jenna Bernstein, MD |
| author_facet | Swaroopa Vaidya, MS Gregory Panza, PhD Jake Laverdiere, BS Dianne Vye, MSN, RN, ONC Jenna Bernstein, MD |
| author_sort | Swaroopa Vaidya, MS |
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| description | 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. |
| format | Article |
| id | doaj-art-a6549b9483ec424eafbbbb269d42bb7f |
| institution | Kabale University |
| issn | 2352-3441 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj-art-a6549b9483ec424eafbbbb269d42bb7f2025-02-10T04:34:28ZengElsevierArthroplasty Today2352-34412025-02-0131101592A Contemporary Analysis of Discharge Disposition Following Total Joint ArthroplastySwaroopa Vaidya, MS0Gregory Panza, PhD1Jake Laverdiere, BS2Dianne Vye, MSN, RN, ONC3Jenna Bernstein, MD4Connecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USA; Corresponding author. Swaroopa Vaidya, MS, Hartford Healthcare, 2800 Main Street, Bridgeport, CT 06606, USA. Tel.: +1 475 210 4287.Hartford HealthCare Research Program, Hartford Healthcare, Hartford, CT, USAFrank H. Netter School of Medicine at Quinnipiac University, North Haven, USAConnecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Meriden, CT, USAConnecticut Orthopaedic Institute, St. Vincent’s Medical Center, Hartford Healthcare, Bridgeport, CT, USABackground: 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.http://www.sciencedirect.com/science/article/pii/S2352344124002772Total joint arthroplastyPreoperative patient characteristicsPatient-reported outcomesSkilled nursing facility |
| spellingShingle | Swaroopa Vaidya, MS Gregory Panza, PhD Jake Laverdiere, BS Dianne Vye, MSN, RN, ONC Jenna Bernstein, MD A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty Arthroplasty Today Total joint arthroplasty Preoperative patient characteristics Patient-reported outcomes Skilled nursing facility |
| title | A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty |
| title_full | A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty |
| title_fullStr | A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty |
| title_full_unstemmed | A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty |
| title_short | A Contemporary Analysis of Discharge Disposition Following Total Joint Arthroplasty |
| title_sort | contemporary analysis of discharge disposition following total joint arthroplasty |
| topic | Total joint arthroplasty Preoperative patient characteristics Patient-reported outcomes Skilled nursing facility |
| url | http://www.sciencedirect.com/science/article/pii/S2352344124002772 |
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