Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement
Year: 2020
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Understand the association between social determinants of health and community discharge after elective total joint arthroplasty. DESIGN: Retrospective cohort design using Optum de-identified electronic health record dataset. SETTING AND PARTICIPANTS: A 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. METHODS: Logistic 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. RESULTS: Mean 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 IMPLICATIONS: Social 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.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,800
Funders: National Institutes of Health, Agency for Healthcare Research and Quality, National Institute on Aging, National Institute of Child Health and Human Development, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Center for Rehabilitation Research Using Large Datasets, Care of the Elder Hospitalized Patient: the Role of the Hospitalist, G2509231690, Rehabilitation Research Career Development Program, Center for Large Data Research and Data Sharing in Rehabilitation, G6238863165, G6361950873, G664684193, G6975323251, Hospital Readmission and Inpatient Medical Rehabilitation, G9000201937, G9000325214, UTMB Claude D. Pepper Older Americans Independence Center, UTMB Clinical and Translational Science Award
OpenAlex ID: W3092502674