Patients had significantly higher odds of being discharged to a post-acute care setting, which increased incremental costs for a 90-day episode of care, if they experienced a complication or received a transfusion during the index hospitalization of total joint arthroplasty, according to results.
Using the MarketScan Commercial Research Database, researchers identified 526,481 adult patients who underwent either a primary unilateral total knee arthroplasty (TKA, 61.5%), primary unilateral total hip arthroplasty (THA, 30.3%), revision TKA (4.8%) or revision THA (3.4%) and had continuous health plan enrollment from 3 months prior to surgery through 3-month follow-up. Researchers analyzed factors associated with discharge destination and risk of readmission using logistic regression and Cox proportional hazard models and calculated total 90-day costs for different patient pathways of care, dependent on complications, discharge destination and readmission status.
Results showed all-cause complications occurred in 2.5% of patients who underwent primary TKA, 37.2% of patients who underwent revision TKA, 2.6% of patients who underwent primary THA and 35% of patients who underwent revision THA. Patients who experienced complications, transfusions or a length of stay of 3 days or longer had greater odds of being discharged home with home health services or to a skilled nursing facility vs. home under self-care, researchers found. According to results, a greater risk of readmission was associated with patients who were discharged home with home health services or to a skilled nursing facility. Researchers noted a ratio that ranged from 1.8 to 2.2 for the total 90-day costs for the highest- vs. lowest-cost care pathways. – by Casey Tingle
Disclosures: Nichols is a paid employee of Medtronic Advanced Energy Inc. and has stock with Medtronic Inc. Please see the full study for a list of all other authors relevant financial disclosures.