Who’s Going Home, Who’s Going to Rehab after TKA

    With implementation of bundled payment models for joint replacement procedures, surgeons have been looking for opportunities to reduce expenses in an episode of care – for example, sending patients home after surgery instead of to a more-costly rehabilitation facility.

    Not all patients will do well at home right away, however. Are there factors that can predict which patients will need extra help in the postoperative period and should go to a rehabilitation facility first?

    To find out, Nicholas Schraut, MD, and his colleagues from the University of Massachusetts in Worcester evaluated data from the National Hospital Discharge Survey database on discharge disposition for more than 25,000 primary total knee arthroplasty (TKA) patients who underwent the procedure between 2001 and 2010.

    They analyzed the following:

    • Patient demographics
    • Hospital length of stay (LOS)
    • In-hospital adverse events (deep vein thrombosis, pulmonary embolus, blood transfusion, and mortality)
    • Discharge disposition

    About two-thirds (65%) of patients in this cohort were discharged home. The one-third (35%) who were discharged to a rehabilitation facility were typically:

    • Female (40.5% vs 25.6%; P<0.0001)
    • Older (70.1 years vs 63.8 years; P<0.0001)
    • Single (46.7% vs 26.6%; P<0.0001)

    They had a longer LOS (3.9 days vs 3.6; P<0.0001) and more co-morbidities (5.3 vs 4.8; P<0.0001).

    We asked Dr. Schraut, who presented the findings at ICJR’s Pan Pacific Orthopaedic Congress, to answer a few questions about the study. Click the image above to hear his comments.


    Schraut N, Jones S, Moretti V, Franklin P, Ayers D. National patients factors correlated with discharge to home and rehabilitation following primary total knee arthroplasty. Presented at the 3rd Annual Pan Pacific Orthopaedic Congress, August 12-15, 2016, in Kona, Hawaii.