Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement |
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| Institution: | 1. Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA;2. Department of Occupational Therapy, Yonsei University, Wonju-si, South Korea;3. Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA;4. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;5. Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA |
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| Abstract: | ObjectivesUnderstand the association between social determinants of health and community discharge after elective total joint arthroplasty.DesignRetrospective cohort design using Optum de-identified electronic health record dataset.Setting and ParticipantsA total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018.MethodsLogistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics.ResultsMean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76–0.85; knee: OR 0.73, 95% CI 0.69–0.77], current smoking (hip: OR 0.82, 95% CI 0.77–0.88; knee: OR 0.90, 95% CI 0.85–0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50–0.60; knee: OR 0.57, 95% CI 0.53–0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively.Conclusions and ImplicationsSocial determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder. |
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| Keywords: | Social behavior discharge planning electronic health record hip arthroplasty knee arthroplasty |
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