Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA.
J Orthop Surg Res. 2024 Nov 28;19(1):806. doi: 10.1186/s13018-024-05294-7.
The purpose of this retrospective cohort study was to assess differences in complication rates, early readmission rates, and reasons for readmission following TKA based on discharge destination. Secondarily, we aimed to identify independent risk factors for developing any adverse event (AAE) in the 30-day postoperative period.
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) was filtered using current procedural terminology (CPT) codes to identify patients undergoing TKA from 2015 to 2020. Patients were divided into three cohorts based on discharge destination: home, skilled nursing facility (SNF), or inpatient rehabilitation facility (IRF). Propensity score matching was used to account for confounding variables. Statistical analysis was conducted using one-way analysis of variance (ANOVA), Chi-square tests, and multivariable logistic regression.
352,824 patients were initially identified with 303,375 discharged home, 31,635 discharged to SNF, and 17,814 discharged to IRF. Following propensity score matching, there were 5,000 patients in each cohort. Regarding postoperative complications, the home cohort had significantly a lower readmission rate (p = 0.01) and rate of any adverse event (p < 0.001) when compared to the IRF and SNF cohorts. The IRF cohort had a significantly higher rate of AAE than the SNF cohort or the home cohort. On multivariable analysis, increasing age, increasing BMI, increasing length of hospital stay, male sex, American Society of Anesthesiologists (ASA) classification four, and history of COPD were all found to be independent risk factors for developing AAE.
This study demonstrates that patients who are discharged to a rehabilitation facility or SNF following TKA experienced significantly higher rates of readmission and postoperative complications than patients discharged home, even after controlling for baseline demographic differences and comorbidities. Given the high financial burden associated with these facilities, it is important for physicians to consider these potential impacts on outcomes when determining patient disposition following TKA.
本回顾性队列研究的目的是评估基于出院去向的 TKA 后并发症发生率、早期再入院率和再入院原因的差异。其次，我们旨在确定 30 天术后期间发生任何不良事件 (AAE) 的独立风险因素。
使用当前手术程序术语 (CPT) 代码筛选美国外科医师学院 (ACS) 国家手术质量改进计划 (NSQIP)，以确定 2015 年至 2020 年期间接受 TKA 的患者。根据出院去向将患者分为三组：家庭、熟练护理机构 (SNF) 或住院康复机构 (IRF)。使用倾向评分匹配来考虑混杂变量。使用单因素方差分析 (ANOVA)、卡方检验和多变量逻辑回归进行统计分析。
最初确定了 352824 名患者，其中 303375 名患者出院回家，31635 名患者出院到 SNF，17814 名患者出院到 IRF。在进行倾向评分匹配后，每个队列各有 5000 名患者。关于术后并发症，与 IRF 和 SNF 队列相比，家庭队列的再入院率（p=0.01）和任何不良事件发生率（p<0.001）显著较低。IRF 队列的 AAE 发生率明显高于 SNF 队列或家庭队列。多变量分析显示，年龄增长、BMI 增加、住院时间延长、男性、美国麻醉医师协会 (ASA) 分级四和 COPD 病史均为发生 AAE 的独立风险因素。
本研究表明，与出院回家的患者相比，TKA 后出院到康复机构或 SNF 的患者经历再入院和术后并发症的发生率明显更高，即使在控制了基线人口统计学差异和合并症后也是如此。鉴于这些机构相关的高昂经济负担，医生在确定 TKA 后患者的处置方式时，应考虑这些对结果的潜在影响。
