Trends in Discharge to Institutional Post‐Acute Care After Total Joint Arthroplasty in the United States and Canada

Background Recent payment reforms in the United States have been credited with reducing the use of institutional post‐acute care (PAC) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). This dual‐country study of Canada and the United States compares longitudinal trends in discharge to institutional PAC after primary TKA or THA. Methods We conducted serial cross‐sectional analyses to compare discharge to institutional PAC trends among adults aged ≥ 66 years undergoing primary TKA or THA in the United States and Canada from 2013 to 2019. Patient‐level data were obtained from population‐based Medicare claims in the United States and analogous datasets in Ontario. Discharge trends were assessed using standardized differences and linear regression models to evaluate relative changes over time. Results Patients receiving TKA (2,308,001) and THA (1,234,149) in the United States and Ontario (106,721 and 53,371, respectively) were similar in age (73–74 years) and sex (~60% female). The absolute reduction in institutional PAC discharge over time for TKA was greater in the United States (slope = −3.59) than in Canada (slope = −0.53) ( p < 0.0001), but relative reductions (slope = −8.78 in the United States, slope = −6.99 in Canada) were statistically similar ( p = 0.08). THA showed a similar trend of absolute reductions; however, the relative reduction trend in the United States (slope = −9.98) was steeper than in Canada (slope = −6.46) ( p = 0.0009). Conclusions The US payment reforms from 2013 to 2019 were associated with a greater impact on reducing institutional PAC utilization for THA than for TKA.