Skilled Nursing Facility Outcomes Following Primary Total Hip Arthroplasty

Friday, November 11, 2022

9:53 AM – 9:58 AM

Location: Station 8

Presenting Author(s)

BA

Brandon Amirian, n/a

Medical Student
SUNY Downstate Health Sciences University
Great Neck, New York, United States

Non-presenting Author(s)

WB

Weston Buehring, n/a

Student
SUNY Downstate, United States
RV

Rushabh B. Vakharia

Research Fellow
Maimonides Medical Center, Department of Orthopaedics, United States

Research Objectives: To investigate whether primary THA patients discharged to a skilled nursing facility (SNF) have higher rates of (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) cost of care as , patient discharge remains an overlooked area of concern in terms of optimal patient recovery and cost expenditure.

Design: A retrospective query from January 1st, 2005 to March 31st, 2014 was performed of the 100% Medicare Standard Analytical Files from the PearlDiver (PearlDiver Technologies, Fort Wayne, Indiana) supercomputer.

Setting: Patients discharged to a SNF undergoing primary THA were identified and matched to controls in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 806,546 patients discharged either to a SNF (n = 134,434) or discharged elsewhere (n = 672,112).

Participants: The inclusion criteria for the study group consisted of all patients undergoing primary THA and discharged to a skilled nursing facility, whereas, patients not discharged to a SNF served as controls.

Interventions: Not Applicable

Main Outcome Measures: Primary outcomes analyzed included in-hospital LOS, 90-day medical complications, and costs of care.

Results: Patients discharged to a SNF had significantly longer in-hospital LOS (4- vs. 3-days, P < 0.0001), higher incidence and odds of 90-day medical complications (18.72 vs. 13.41%, OR: 1.47, P < 0.0001), and significantly higher 90-day EOC costs ($16,428.73 vs. $15,280.91, P < 0.0001). Additionally, specific medical complications were found to occur at an increased frequency for patients discharged to a SNF

Conclusions: Upon adjusting for age, sex, and comorbidities, the study was able to demonstrate that patients discharged to a SNF have increased rates of in-hospital LOS, 90-day medical complications, and cost.

Author(s) Disclosures: No conflicts to disclose

Learning Objectives:

Upon completion, participant will be able to understand the importance of proper discharge on a patient's health and outcomes
Recognize that patients requiring discharge to a skilled nursing facility are often considered less healthy in terms of age, comorbidities and functional status prior to surgery
Upon completion, participant will be able to appreciate that future prospective randomized controlled studies comparing outcomes of discharge disposition following primary total hip arthroplasty may be warranted.