Factors Affecting Discharge Disposition After Primary Simultaneous Bilateral Joint Arthroplasty

Abstract

Background

Predicting discharge destination following total joint arthroplasty (TJA) is important, as discharge destination has major implications for post-operative costs, clinical outcomes, and readmissions. Few studies have looked at factors affecting discharge destination for patients following primary simultaneous bilateral total joint arthroplasty.

Questions/Purposes

The purpose of this study was to describe clinical and social factors that relate to a discharge to home versus rehabilitation facility (RF) for patients after primary simultaneous bilateral total hip arthroplasty (PSBTHA) or primary simultaneous bilateral total knee arthroplasty (PSBTKA).

Methods

The inclusion criteria for this retrospective cohort study were all patients after PSBTHA or PSBTKA at a metropolitan orthopedic specialty hospital between February 1, 2016, and March 31, 2018. Exclusion criteria were revisions, differing weight-bearing status, bed-rest orders, and non-standard hip precautions. Social and clinical demographic data were collected. Multiple regression analysis was conducted to determine which factors related most to discharge plan.

Results

Of 253 PSBTHA patients, 153 were discharged home and 100 to an RF. Regression analysis found a posterolateral approach to be the only significant factor associated with an RF discharge. Of 619 PSBTKA patients, 136 were discharged home and 483 to RF. Increased body mass index and older age increased the likelihood of discharge to an RF. Patients with an adductor-only nerve block were more likely to be sent to RF.

Conclusion

These findings shed light on the variables that contribute to discharge destination after PSBTHA and PSBTKA. Such information allows for safe pre-operative discharge planning and assists with discharge to the appropriate level of patient care. Future studies might investigate the effect of surgeon experience, surgical technique, and pre-operative discussion with a physical therapist on the discharge disposition of patients undergoing bilateral total joint arthroplasty.

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Correspondence to Danielle Edwards PT, DPT.

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Conflict of Interest

Danielle Edwards, PT, DPT, Allison Anderson, PT, DPT, Michael R. Pleus, PT, DPT, and Jerome B. Smith, PT, DPT, declare that they have no conflicts of interest. Joseph T. Nguyen, MPH, was supported in part by funds from the Clinical Translational Science Center (CTSC), National Center for Advancing Translational Sciences (NCATS) grant #UL1-RR024996. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS, based in Rockville, MD.

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.

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

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Level of Evidence: Level III: Retrospective Cohort Study.

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Edwards, D., Anderson, A., Pleus, M.R. et al. Factors Affecting Discharge Disposition After Primary Simultaneous Bilateral Joint Arthroplasty. HSS Jrnl 15, 254–260 (2019). https://doi.org/10.1007/s11420-019-09701-2

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Keyword

  • bilateral hip arthroplasty
  • bilateral knee arthroplasty
  • bilateral total joint arthroplasty discharge factors