J Knee Surg 2021; 34(06): 644-647
DOI: 10.1055/s-0039-1700491
Original Article

Factors Complicating Discharge to Home following Total Knee Arthroplasty—A Single Institution Initiative

Kimona Issa
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
Thomas A. Novack
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
Todd P. Pierce
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
Anthony Festa
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
Anthony J. Scillia
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
,
Vincent K. McInerney
1   Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Main St. Paterson, New Jersey
› Author Affiliations

Abstract

Recently, with the Medicare bundled payments initiative for total knee arthroplasty (TKA), there has been a move by many institutions to further streamline costs associated with the entire operative and perioperative process. One of these cost-saving strategies has been to favor discharging patients to home with outpatient services as opposed to discharging to the relatively more expensive rehabilitation facilities. Our aim was to determine the success of a teaching institute's initiative in discharging patients to home instead of a rehabilitation facility. Specifically, we evaluated if there were differences in discharge disposition based off of (1) surgeon/patient preference, (2) length of stay, (3) demographics, and (4) postoperative complications. A retrospective review of all patients who had a TKA from 2015 to 2017 at a single teaching institution was performed and assessed discharge to home or to a rehabilitation facility. If they were not discharged to home, we evaluated why that did not happen, stratified the reason they were discharged to a rehabilitation facility into four groups based on (1) physician and occupational health team assessment, (2) patient preference, (3) physician preference, and (4) family or caretaker preference. A total of 229 patients were enrolled in this initiative, with 107 patients (47%) discharged to home with outpatient physical therapy services and 122 (53%) discharged to a rehabilitation facility. Of these, 35 patients (29%) went to these facilities because of physician and occupational health team assessment. However, 31 (25%) patients were due to patient preference, 32 (26%) were because of surgeon's preference, and 24 (20%) were not discharged to home because of family or caretaker preference. There were no differences in length of stay, gender, or complication rates between cohorts. Many patients can be safely discharged to home following TKA at a community teaching institution; however, there continues to be a strong prejudice by patients, physicians, and caretakers to be discharged to a rehabilitation facility despite the home discharge initiative.



Publication History

Received: 10 December 2018

Accepted: 01 September 2019

Article published online:
22 October 2019

© 2019. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Inacio MCS, Paxton EW, Graves SE, Namba RS, Nemes S. Projected increase in total knee arthroplasty in the United States - an alternative projection model. Osteoarthritis Cartilage 2017; 25 (11) 1797-1803
  • 2 Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 2014; 472 (01) 188-193
  • 3 Barsoum WK, Murray TG, Klika AK. et al. Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty 2010; 25 (06) 885-892
  • 4 London DA, Vilensky S, O'Rourke C, Schill M, Woicehovich L, Froimson MI. Discharge disposition after joint replacement and the potential for cost savings: effect of hospital policies and surgeons. J Arthroplasty 2016; 31 (04) 743-748
  • 5 Sabeh KG, Rosas S, Buller LT, Roche MW, Hernandez VH. The impact of discharge disposition on episode-of-care reimbursement after primary total hip arthroplasty. J Arthroplasty 2017; 32 (10) 2969-2973
  • 6 Munday GS, Deveaux P, Roberts H, Fry DE, Polk HC. Impact of implementation of the surgical care improvement project and future strategies for improving quality in surgery. Am J Surg 2014; 208 (05) 835-840
  • 7 Rosenberger LH, Politano AD, Sawyer RG. The surgical care improvement project and prevention of post-operative infection, including surgical site infection. Surg Infect (Larchmt) 2011; 12 (03) 163-168
  • 8 Keswani A, Tasi MC, Fields A, Lovy AJ, Moucha CS, Bozic KJ. Discharge destination after total joint arthroplasty: an analysis of postdischarge outcomes, placement risk factors, and recent trends. J Arthroplasty 2016; 31 (06) 1155-1162
  • 9 Fleischman AN, Austin MS, Purtill JJ, Parvizi J, Hozack WJ. Patients living alone can be safely discharged directly home after total joint arthroplasty: a prospective cohort study. J Bone Joint Surg Am 2018; 100 (02) 99-106