考虑全膝关节置换术后再入院风险的活动能力状态和家庭环境。
Considering Mobility Status and Home Environment in Readmission Risk After Total Knee Arthroplasty.
机构信息
Department of Physical Medicine and Rehabilitation, Cleveland Clinic Foundation, Cleveland, Ohio.
Center for Value-Based Care Research, Cleveland Clinic Foundation, Cleveland, Ohio.
出版信息
J Bone Joint Surg Am. 2023 Dec 20;105(24):1987-1992. doi: 10.2106/JBJS.23.00581. Epub 2023 Oct 19.
BACKGROUND
Discharge disposition following total knee arthroplasty (TKA) offers varying levels of post-acute care monitoring depending on the medical status of the patient and his or her ability to function independently. Discharge disposition following TKA is associated with 30-day and 90-day hospital readmission, but prior studies have not consistently considered confounding due to mobility status after TKA, available caregiver support, and measures of home area deprivation. The purpose of this study was to examine 30-day and 90-day readmission risk for patients discharged to a skilled nursing facility (SNF) following TKA after controlling specifically for these factors, among other covariates.
METHODS
This was a retrospective cohort study of patients undergoing TKA at any of 11 hospitals in a single, large, academic health-care system between January 2, 2017, and August 31, 2022, who were discharged to an SNF or home health care (HHC). The adjusted relative risk of readmission within 30 and 90 days of discharge to an SNF compared with HHC was estimated using modified Poisson regression models.
RESULTS
There were 15,212 patients discharged to HHC and 1,721 patients discharged to SNFs. Readmission within 30 days was 7.1% among patients discharged to SNFs and 2.4% among patients discharged to HHC; readmission within 90 days was 12.1% for the SNF group and 4.8% for the HHC group. The adjusted relative risk after discharge to an SNF was 1.07 (95% confidence interval [CI], 0.79 to 1.46; p = 0.65) for 30-day readmission and 1.45 (95% CI, 1.16 to 1.82; p < 0.01) for 90-day readmission.
CONCLUSIONS
Discharge to an SNF compared with HHC was independently associated with 90-day readmission, but not with 30-day readmission, after controlling for mobility status after TKA, available caregiver support, and home Area Deprivation Index, among other covariates.
LEVEL OF EVIDENCE
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
背景
全膝关节置换术（TKA）后的出院去向提供了不同程度的术后急性护理监测，具体取决于患者的身体状况及其独立功能的能力。TKA 后的出院去向与 30 天和 90 天的医院再入院有关，但先前的研究并未一致考虑 TKA 后移动能力、可用护理人员支持以及家庭区域剥夺措施等因素造成的混杂。本研究的目的是在控制这些因素以及其他协变量的情况下，专门检查 TKA 后被送往熟练护理机构（SNF）的患者的 30 天和 90 天再入院风险。
方法
这是一项回顾性队列研究，纳入 2017 年 1 月 2 日至 2022 年 8 月 31 日期间在单一大型学术医疗保健系统的 11 家医院接受 TKA 的患者，这些患者出院后被送往 SNF 或家庭健康护理（HHC）。使用修正泊松回归模型估计与 HHC 相比，出院后 30 天和 90 天内被送往 SNF 的患者的再入院调整后相对风险。
结果
有 15212 名患者出院至 HHC，1721 名患者出院至 SNF。出院至 SNF 的患者在 30 天内再入院的比例为 7.1%，出院至 HHC 的患者为 2.4%；出院至 SNF 的患者在 90 天内再入院的比例为 12.1%，出院至 HHC 的患者为 4.8%。调整后，出院至 SNF 的患者 30 天内的调整后相对风险为 1.07（95%置信区间[CI]，0.79 至 1.46；p=0.65），90 天内的调整后相对风险为 1.45（95%CI，1.16 至 1.82；p<0.01）。
结论
在控制 TKA 后移动能力、可用护理人员支持和家庭区域剥夺指数等其他协变量后，与 HHC 相比，出院至 SNF 与 90 天内再入院独立相关，但与 30 天内再入院无关。
证据水平
治疗性 3 级。有关证据水平的完整描述，请参阅作者说明。
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