Race, Rehabilitation, and 30-Day Readmission After Elective Total Knee Arthroplasty

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2015 Dec 2

PMID 26623166

Citations 24

Authors

Erik S Jorgenson

Diane M Richardson

Arwin M Thomasson

Charles L Nelson

Said A Ibrahim

Affiliations

Soon will be listed here.

Abstract

Introduction: To examine racial variations in access to postacute care (PAC) and rehabilitation (Rehab) services following elective total knee arthroplasty and whether where patients go after surgery for PAC/Rehab is associated with 30-day readmission to acute care facility.

Materials And Methods: Sample consisted of 129 522 patients discharged from 169 hospitals in the State of Pennsylvania between fiscal years 2008 and 2012. We used multinomial regression models to assess the relationship between patient race and discharge destination after surgery, for patients aged 18 to 64 years and for those aged 65 and older. We used multivariable (MV) regression and propensity score (PS) approaches to examine the relationship between patient discharge destination after surgery for PAC/Rehab and 30-day readmission, controlling for key individual- and facility-level factors.

Results: Lower proportions of younger patients compared to those older than 65 were discharged to inpatient rehabilitation facilities (IRFs; 5.8% vs 12.6%, respectively) and skilled nursing facilities (SNFs; 15.2% vs 32.7%, respectively) compared to home-based Rehab (self-care; 23.3% vs 14.2%, respectively). Compared to whites, African American patients had significantly higher odds of discharge to IRF (age < 65, odds ratio = 2.04; age ≥ 65, odds ratio = 1.64) and to SNF (age < 65, odds ratio = 2.86; age ≥ 65, odds ratio = 2.19) and discharge to home care in patients younger than 65 years (odds ratio = 1.31). The odds of 30-day readmission among patients discharged to an IRF (MV odds ratio = 7.76; PS odds ratio = 8.34) and SNF (MV odds ratio = 2.01; PS odds ratio = 1.83) were significantly higher in comparison to patients discharged home with self-care.

Conclusion: African American patients with knee replacement are more likely to be discharged to inpatient Rehab settings following surgery. Inpatient Rehab is significantly associated with 30-day readmission to acute care facility.

Citing Articles

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Lynch D, Romero A, McFadden J, Zeblisky P, Liu H, Ang D Orthop Surg. 2024; 17(1):252-259.

PMID: 39545453 PMC: 11735350. DOI: 10.1111/os.14290.

Outcomes by Race and Ethnicity Following a Medicare Bundled Payment Program for Joint Replacement.

Kim N, Jacobson M JAMA Netw Open. 2024; 7(9):e2433962.

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The Investigation of Preoperative Factors Associated With Postoperative Outcomes Following Total Knee Arthroplasty for Osteoarthritis: A Scoping Review.

Nasu T, Yamanoi J, Kitagawa T Cureus. 2024; 16(7):e64989.

PMID: 39161506 PMC: 11333026. DOI: 10.7759/cureus.64989.

Racial and Ethnic Disparities in Primary Total Knee Arthroplasty Outcomes: A Systematic Review and Meta-Analysis of Two Decades of Research.

Balachandran M, Prabhakar S, Zhang W, Parks M, Ma Y J Racial Ethn Health Disparities. 2024; .

PMID: 39158831 DOI: 10.1007/s40615-024-02105-x.

Post-Acute Care Trends and Disparities After Joint Replacements in the United States, 1991-2018: A Systematic Review.

Morse-Karzen B, Lee J, Stone P, Shang J, Chastain A, Dick A J Am Med Dir Assoc. 2024; 25(9):105149.

PMID: 39009064 PMC: 11368643. DOI: 10.1016/j.jamda.2024.105149.

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