Race and Rehabilitation Destination After Elective Total Hip Arthroplasty: Analysis of a Large Regional Data Set

Overview

Journal Geriatr Orthop Surg Rehabil

Publisher Sage Publications

Specialty Geriatrics

Date 2018 Jan 11

PMID 29318080

Citations 4

Authors

Ernest R Vina

Michael J Kallan

Aliya Collier

Charles L Nelson

Said A Ibrahim

Affiliations

Soon will be listed here.

Abstract

Background: Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission.

Methods: Using the Pennsylvania Health Care Cost Containment Council database, we selected African American (AA) or white adults who underwent THR surgery (n = 68,016). We used multinomial logistic regression models to assess the relationship between race and postsurgical discharge destination. We calculated 90-day hospital readmission as function of discharge destination.

Results: Among patients <65 years, compared to whites, AAs had a higher risk of discharge to an IRF (adjusted relative risk ratio [aRRR]: 2.56, 95% confidence interval [CI]: 1.77-3.71) and a SNF (aRRR 3.37, 95% CI: 2.07-5.49). Among those ≥65 years, AA patients also had a higher risk of discharge to an IRF (aRRR: 1.96, 95% CI: 1.39-2.76) and a SNF (aRRR: 3.66, 95% CI: 2.29-5.84). Discharge to either IRF or SNF, instead of home with self-care, was significantly associated with higher odds of 90-day hospital readmission (<65 years: adjusted odds ratio [aOR]: 4.06, 95% CI: 3.49-4.74; aOR: 2.05, 95% CI: 1.70-2.46, respectively; ≥65 years: aOR: 4.32, 95% CI: 3.67-5.09, respectively; aOR: 1.74, 95% CI: 1.46-2.07, respectively).

Conclusions: Compared to whites, AAs who underwent THR were more likely to be discharged to an IRF or SNF. Discharge to either facility was associated with a higher risk of hospital readmission.

Citing Articles

Bias in Care: Impact of Ethnicity on Time to Emergent Surgery Varies Between Subspecialties.

Blumenthal S, Fryhofer G, Serra-Lopez V, Pierrie S, Mehta S J Am Acad Orthop Surg Glob Res Rev. 2023; 7(6).

PMID: 37311114 PMC: 10266510. DOI: 10.5435/JAAOSGlobal-D-23-00060.

Racial disparities in peri-operative complications following primary total hip arthroplasty.

Johnson M, Sloan M, Lopez V, Andah G, Sheth N, Nelson C J Orthop. 2020; 21:155-160.

PMID: 32255997 PMC: 7114726. DOI: 10.1016/j.jor.2020.03.037.

Community Deprivation Index and Discharge Destination After Elective Hip Replacement.

Mehta B, Goodman S, Ho K, Parks M, Ibrahim S Arthritis Care Res (Hoboken). 2020; 73(4):531-539.

PMID: 31961488 PMC: 7371507. DOI: 10.1002/acr.24145.

Race, Discharge Disposition, and Readmissions After Elective Hip Replacement: Analysis of a Large Regional Dataset.

Mehta B, Singh J, Ho K, Parks M, Nelson C, DAngelo D Health Equity. 2019; 3(1):628-636.

PMID: 31872168 PMC: 6922058. DOI: 10.1089/heq.2019.0083.

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