Patient disposition after discharge following primary total hip arthroplasty: home versus skilled nursing facility-a study based on national inpatient sample database

Abstract

Introduction: In view of the shortened length of hospital stay following THA, an increasing proportion of patients have required transfer to "extended-care" (ECF) or "skilled nursing" facilities (SNF) over the past years. As a result, the expenditure related to postoperative care facility has been acknowledged as a crucial component of total economic burden associated with THA. In this context, the clinical and demographic factors leading to the need for transfer of patients to SNF following primary THA need to be clearly understood.

Methods: The NIS database was utilised to identify the patients, who underwent primary THA between 2016 and 2019. The patients were then grouped under two categories: group A-patients who required post-THA transfer to SNF; and group B-those who were discharged home. The details regarding patients' demographic profile, medical comorbidities and complication profile during the perioperative period were recorded; and compared between groups A and B.

Results: Based on the database, 368,431 patients underwent primary THA between 2016 and 2019; among whom, 67,498 (18.3%) were transferred to SNF (group A) following the surgery. Among the various comorbidities evaluated [on multivariate analysis (MVA)], uncomplicated DM (OR 1.45; p < 0.001), CKD (OR 1.47; p < 0.001), cirrhosis (OR 1.83; p < 0.001), Parkinson's disease (OR 3.94; p < 0.001), previous H/O dialysis (OR 2.84; p < 0.001), colostomy (OR 2.03; p < 0.001) or organ transplant (OR 1.42; p < 0.001); morbid obesity (OR 1.72; p < 0.001), cocaine abuse (OR 1.76; p < 0.001); and legal blindness (OR 2.58; p < 0.001) were associated with significantly greater need for post-THA transfer to SNF. Among the systemic complications reviewed (on MVA), pneumonia (odds ratio 3.2; p < 0.001), DVT (odds ratio 2.58; p < 0.001), higher need for blood transfusions (odds ratio 2.55; p < 0.001), ARF (odds ratio 2.32; p < 0.001), MI (odds ratio 2.2; p < 0.001), anaemia (odds ratio 1.65; p = 0.002) and PE (odds ratio 1.56; p < 0.001) significantly raised the probability of need for higher discharge destinations. In addition, prosthesis-related local complications such as prosthetic dislocation (OR 1.59; p < 0.001), fracture (OR 2.64; p < 0.001) or early peri-prosthetic infection (PPI; OR 1.71; p = 0.01) also necessitated specialised facilities of care following THA.

Conclusion: We could observe that 0.2% of patients required transfer to SNF following primary THA. Comorbidities such as Parkinson's disease, previous H/O dialysis, legal blindness and H/O colostomy had the highest odds of necessitating patient disposition to SNF. The occurrence of one or more systemic complications including pneumonia, DVT, ARF, MI, PE, and blood loss anaemia (or need for blood transfusion) or local prosthesis-related complications (dislocation, fracture or infections) substantially increased the chances of requiring transfer to a specialised care facility.

Keywords: Home discharge; Length of stay; Outcome; Postoperative; Skilled nursing facility; Total hip arthroplasty.