Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Predicting Need for Skilled Nursing or Rehabilitation Facility after Outpatient Total Hip Arthroplasty

  • Elshaday Belay (Department of Orthopaedic Surgery, Duke University Medical Center) ;
  • Patrick Kelly (Department of Orthopaedic Surgery, Duke University Medical Center) ;
  • Albert Anastasio (Department of Orthopaedic Surgery, Duke University Medical Center) ;
  • Niall Cochrane (Department of Orthopaedic Surgery, Duke University Medical Center) ;
  • Mark Wu (Department of Orthopaedic Surgery, Duke University Medical Center) ;
  • Thorsten Seyler (Department of Orthopaedic Surgery, Duke University Medical Center)
  • Received : 2022.04.20
  • Accepted : 2022.08.24
  • Published : 2022.12.31
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Abstract

Purpose: Outpatient classified total hip arthroplasty (THA) is a safe option for a select group of patients. An analysis of a national database was conducted to understand the risk factors for unplanned discharge to a skilled nursing facility (SNF) or acute rehabilitation (rehab) after outpatient classified THA. Materials and Methods: A query of the National Surgical Quality Improvement Program (NSQIP) database for THA (Current Procedural Terminology [CPT] 27130) performed from 2015 to 2018 was conducted. Patient demographics, American Society of Anesthesiologists (ASA) classification, functional status, NSQIP morbidity probability, operative time, length of stay (LOS), 30-day reoperation rate, readmission rate, and associated complications were collected. Results: A total of 2,896 patients underwent outpatient classified THA. The mean age of patients was 61.2 years. The mean body mass index (BMI) was 29.6 kg/m2 with median ASA 2. The results of univariate comparison of SNF/rehab versus home discharge showed that a significantly higher percentage of females (58.7% vs. 46.8%), age >70 years (49.3% vs. 20.9%), ASA ≥3 (58.0% vs. 25.8%), BMI >35 kg/m2 (23.3% vs. 16.2%), and hypoalbuminemia (8.0% vs. 1.5%) (P<0.0001) were discharged to SNF/rehab. The results of multivariable logistic regression showed that female sex (odds ratio [OR] 1.47; P=0.03), age >70 years (OR 3.08; P=0.001), ASA≥3 (OR 2.56; P=0.001), and preoperative hypoalbuminemia (<3.5 g/dL) (OR 3.76; P=0.001) were independent risk factors for SNF/rehab discharge. Conclusion: Risk factors associated with discharge to a SNF/rehab after outpatient classified THA were identified. Surgeons will be able to perform better risk stratification for patients who may require additional postoperative intervention.

Keywords

References

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