Chukwuweike U Gwam1, Nequesha S Mohamed2, Iciar M Dávila Castrodad3, Nicole E George4, Ethan A Remily2, Wayne A Wilkie2, Victoria Barg2, Wahab A Gbadamosi2, Ronald E Delanois5. 1. Department of Orthopedic Surgery, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, United States of America. 2. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States of America. 3. Hackensack Meridian School of Medicine at Seton Hall University, Department of Orthopedic Surgery, 340 Kingsland Street, Nutley, NJ 07110, United States of America. 4. Aultman Hospital, Dept. of Graduate Medical Education, 2600 6th St. SW, Canton, OH 44710, United States of America. 5. Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215, United States of America. Electronic address: delanois@me.com.
Abstract
INTRODUCTION: Increasing demand for total knee arthroplasties (TKA) has been targeted by legislation to minimize costs and maximize outcomes. Home discharges reduce costs, and it is important to determine patient variables associated with this discharge disposition. We explored non-modifiable and modifiable factors associated with non-home discharges to determine what patient specific factors require attention. METHODS: This retrospective study included 171,903 National Surgical Quality Improvement Program (NSQIP) patients between 2011 and 2016. Patient specific variables and discharge destinations included home, short-term nursing facilities (SNF), not home, and rehabilitation. Chi-squared analyses and analyses of variance (ANOVA) were conducted for categorical and continuous data, respectively. Multinomial regression model was utilized to assess associations between discharge destination and patient specific variables. RESULTS: Every year increase above the mean age (66 years) was associated with a nine percent (p < .001) and six percent (p < .001) increased odds for discharge to SNF or rehabilitation, respectively, compared to home discharges. Every 10% increase in BMI from the mean was associated with a 10% increase in discharge to both SNF and rehabilitation (p < .001 for both). CONCLUSION: With increasing demands for TKAs and expenditures to Medicare, evaluating factors that impact patient discharge can help optimize costs and outcomes of TKA procedures. Arthroplasty surgeons can benefit by recognizing these correlations and exploring reductions to non-home discharges through pre-operative patient optimization. Future studies should evaluate the economic cost potential associated with optimizing routine home discharge in TKA patients. LEVEL OF EVIDENCE: IV.
INTRODUCTION: Increasing demand for total knee arthroplasties (TKA) has been targeted by legislation to minimize costs and maximize outcomes. Home discharges reduce costs, and it is important to determine patient variables associated with this discharge disposition. We explored non-modifiable and modifiable factors associated with non-home discharges to determine what patient specific factors require attention. METHODS: This retrospective study included 171,903 National Surgical Quality Improvement Program (NSQIP) patients between 2011 and 2016. Patient specific variables and discharge destinations included home, short-term nursing facilities (SNF), not home, and rehabilitation. Chi-squared analyses and analyses of variance (ANOVA) were conducted for categorical and continuous data, respectively. Multinomial regression model was utilized to assess associations between discharge destination and patient specific variables. RESULTS: Every year increase above the mean age (66 years) was associated with a nine percent (p < .001) and six percent (p < .001) increased odds for discharge to SNF or rehabilitation, respectively, compared to home discharges. Every 10% increase in BMI from the mean was associated with a 10% increase in discharge to both SNF and rehabilitation (p < .001 for both). CONCLUSION: With increasing demands for TKAs and expenditures to Medicare, evaluating factors that impact patient discharge can help optimize costs and outcomes of TKA procedures. Arthroplasty surgeons can benefit by recognizing these correlations and exploring reductions to non-home discharges through pre-operative patient optimization. Future studies should evaluate the economic cost potential associated with optimizing routine home discharge in TKA patients. LEVEL OF EVIDENCE: IV.
Authors: Jérôme Grondin; Pierre Menu; Benoit Métayer; Vincent Crenn; Marc Dauty; Alban Fouasson-Chailloux Journal: Antibiotics (Basel) Date: 2021-03-21