Is Post-discharge Rehabilitation Timing Associated with 90-Day Readmission in Primary Total Joint Arthroplasty?

Abstract

Background

Physical therapy (PT) is an accepted standard of care after total joint arthroplasty (TJA) and essential to maximizing joint functionality and minimizing complications that lead to readmission. However, evidence-based guidelines about appropriate post-discharge rehabilitative care are not well-defined in the orthopedic literature.

Purposes

We sought to determine the average timing for receiving PT rehabilitation and to evaluate the association between PT rehabilitation timing and unplanned readmission within 90 days of a TJA patient being discharged home from acute care.

Methods

This retrospective study examined 11,545 joint procedures using claims data for the years 2008 to 2013. Outcomes were assessed using a population-averaged approach to regression models.

Results

The average time for initiating PT was 4 days for knee arthroplasty and 6 days for hip arthroplasty in patients discharged home from acute care. Most patients (89%) began PT consultation or supervised exercises during the first week after discharge. The type of joint surgery considerably modified the effect of rehabilitation timing on the likelihood of readmission. Later initiation of rehabilitation was associated with a higher probability of 90-day readmission in both knee and hip arthroplasty, with the effect of rehabilitation timing being more pronounced in hip rather than knee arthroplasty 2 weeks post-discharge from acute care.

Conclusions

Timing for initiating PT may be an important modifiable factor that can affect readmission in patients discharged home from acute care after TJA. Further exploration of the role of PT timing along with other factors such as dosage and frequency among such patients is needed.

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Correspondence to Shweta Pathak PhD, MPH.

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Conflict of Interest

Shweta Pathak, PhD, MPH, Cecilia M. Ganduglia, MD, DrPH, Wenyaw Chan, PhD, John M. Swint, PhD, and Robert O. Morgan, PhD declare that they have no conflicts of interest. Samir S. Awad, MD, MPH, reports personal fees from TELA Bio, Applied Medical, Abbott Laboratories, and Pacira Pharmaceuticals, as well as grants and personal fees from Miromatrix Medical, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level II, retrospective study.

Work performed at School of Public Health, University of Texas Health Sciences Center, Houston, TX

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Pathak, S., Ganduglia, C.M., Awad, S.S. et al. Is Post-discharge Rehabilitation Timing Associated with 90-Day Readmission in Primary Total Joint Arthroplasty?. HSS Jrnl 15, 234–240 (2019). https://doi.org/10.1007/s11420-019-09685-z

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Keywords

  • total joint arthroplasty
  • physical therapy
  • readmission