Fang Christopher, Lim Sara J, Tybor David J, Martin Joseph, Pevear Mary E, Smith Eric L
Boston University School of Medicine, Boston, MA 02118, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA.
Geriatrics (Basel). 2020 Feb 12;5(1):7. doi: 10.3390/geriatrics5010007.
Patients who are discharged home following primary hip and knee arthroplasty have lower associated costs and better outcomes than patients who are discharged to skilled nursing facilities (SNFs). However, patients who live alone are more likely to be discharged to an SNF. We studied the factors that determine the discharge destination for patients who live alone after total joint arthroplasty (TJA) at an urban tertiary care academic hospital between April 2016 and April 2017. We identified 127 patients who lived alone: 79 (62.2%) were sent home, and 48 (37.8%) were sent to an SNF after surgery. Patients who went home versus to an SNF differed in age, employment status, exercise/active status, patient expectation of discharge to an SNF, ASA score, and the length of stay. After controlling for expectations of discharge to an SNF (OR: 28.98), patients who were younger (OR: 0.03) and employed (OR: 6.91) were more likely to be discharged home. In conclusion, the expectation of discharge location was the strongest predictor of discharge to an SNF even after controlling for age and employment. Future research should include a multi-hospital approach to strengthen the validity of our findings and investigate additional factors that impact discharge destination.
与被送往专业护理机构（SNFs）的患者相比，初次髋关节和膝关节置换术后出院回家的患者相关费用更低，预后更好。然而，独居患者更有可能被送往SNFs。我们研究了2016年4月至2017年4月期间在一家城市三级医疗学术医院接受全关节置换术（TJA）后独居患者出院目的地的决定因素。我们确定了127名单独居住的患者：79名（62.2%）术后被送回家，48名（37.8%）被送往SNFs。回家的患者与被送往SNFs的患者在年龄、就业状况、运动/活动状态、患者对出院至SNFs的期望、美国麻醉医师协会（ASA）评分和住院时间方面存在差异。在控制了出院至SNFs的期望因素后（比值比：28.98），年龄较小（比值比：0.03）和有工作的患者（比值比：6.91）更有可能出院回家。总之，即使在控制了年龄和就业因素后，出院地点的期望仍是出院至SNFs的最强预测因素。未来的研究应采用多医院方法，以加强我们研究结果的有效性，并调查影响出院目的地的其他因素。
