Sabo Graham C, Stern Brocha Z, Balachandran Uma, Agranoff Raquelle, Hayden Brett L, Poeran Jashvant, Moucha Calin S
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
J Arthroplasty. 2025 Mar;40(3):578-583.e1. doi: 10.1016/j.arth.2024.09.013. Epub 2024 Sep 14.
Prehabilitation has potential to improve outcomes in value-based care models. We examined the associations between the receipt of prehabilitation (physical therapy [PT] services within 30 days preoperatively) and postoperative healthcare utilization in a national cohort of fee-for-service Medicare beneficiaries.
This retrospective cohort study used the 5% fee-for-service claims from the Medicare limited data set to identify unilateral elective inpatient total hip arthroplasty (THA) procedures (n = 25,509) and total knee arthroplasty (TKA) procedures (n = 40,091) from January 1, 2016 to September 30, 2021. Associations between prehabilitation and postoperative healthcare utilization were analyzed in mixed-effects generalized linear models adjusting for patient-level and hospital-level factors. We report adjusted odds ratios (OR) or % differences.
Prehabilitation (13.1% THA, 13.1% TKA) was not significantly associated with institutional postacute care discharge, 30-day emergency department visits, or 90-day readmissions. For TKA, prehabilitation was significantly associated with decreased odds of an extended hospital length of stay (OR = 0.86, P = 0.02) and reduced length of stay in an institutional postacute care facility (-5.71%, P = 0.004). In both THA and TKA, prehabilitation was associated with decreased use of 90-day home health physical and/or occupational therapy (THA: OR = 0.82, P = 0.001; TKA: OR = 0.67, P < 0.001). In contrast, prehabilitation in both cohorts was associated with the increased odds of receiving any 90-day outpatient PT (THA: OR = 2.08, P < 0.001; TKA: OR = 2.48, P < 0.001) and an increased number of 90-day outpatient PT visits (THA: +4.04%, P = 0.01; TKA: +5.21%, P < 0.001).
Prehabilitation was associated with some decreases in postoperative healthcare utilization, particularly for TKA. Associations of preoperative PT with increased postoperative outpatient PT may reflect variation in referral patterns or patient access. These results highlight the importance of continued research into the impact of prehabilitation on healthcare utilization, patient outcomes, and episode costs. Additionally, further research should identify which patients would benefit the most from prehabilitation to increase the value of care.
术前康复有潜力改善基于价值的医疗模式的结局。我们在一个按服务收费的医疗保险受益人的全国队列中，研究了术前康复（术前30天内的物理治疗[PT]服务）与术后医疗保健利用之间的关联。
这项回顾性队列研究使用了医疗保险有限数据集5%的按服务收费索赔数据，以识别2016年1月1日至2021年9月30日期间的单侧择期住院全髋关节置换术（THA）手术（n = 25,509）和全膝关节置换术（TKA）手术（n = 40,091）。在调整了患者层面和医院层面因素的混合效应广义线性模型中，分析术前康复与术后医疗保健利用之间的关联。我们报告调整后的比值比（OR）或百分比差异。
术前康复（THA为13.1%，TKA为13.1%）与机构急性后护理出院、30天急诊科就诊或90天再入院无显著关联。对于TKA，术前康复与延长住院时间的几率降低显著相关（OR = 0.86，P = 0.02），且在机构急性后护理设施中的住院时间缩短（-5.71%，P = 0.004）。在THA和TKA中，术前康复均与90天家庭健康物理和/或职业治疗的使用减少相关（THA：OR = 0.82，P = 0.001；TKA：OR = 0.67，P < 0.001）。相比之下，两个队列中的术前康复均与接受任何90天门诊PT的几率增加相关（THA：OR = 2.08，P < 0.001；TKA：OR = 2.48，P < 0.001），以及90天门诊PT就诊次数增加相关（THA：+4.04%，P = 0.01；TKA：+5.21%，P < 0.001）。
术前康复与术后医疗保健利用的一些减少相关，尤其是对于TKA。术前PT与术后门诊PT增加之间的关联可能反映了转诊模式或患者可及性的差异。这些结果凸显了持续研究术前康复对医疗保健利用、患者结局和医疗事件成本影响的重要性。此外，进一步的研究应确定哪些患者将从术前康复中获益最大，以提高护理价值。
