Key result
Skilled nursing facility discharge is linked to ~45% higher 90-day readmission risk versus home health care.
Why the study?
Prior studies linking TKA discharge disposition to readmission have not consistently accounted for confounding from post-TKA mobility status, caregiver support, and home area deprivation.
Does discharge to a skilled nursing facility compared with home health care affect 30-day and 90-day readmission risk in patients undergoing total knee arthroplasty?
Cohort (n=16,933)
Yes
Does discharge to a skilled nursing facility compared with home health care affect 30-day and 90-day readmission risk in patients undergoing total knee arthroplasty?
Discharge to a skilled nursing facility after total knee arthroplasty is independently associated with an increased risk of 90-day readmission, but not 30-day readmission, compared to home health care.
Answers are grounded in this paper and cite their sources.
SNF discharge after TKA was associated with higher 90-day readmission; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Discharge disposition following total knee arthroplasty (TKA) offers varying levels of post-acute care monitoring depending on the medical status of the patient and his or her ability to function independently. Discharge disposition following TKA is associated with 30-day and 90-day hospital readmission, but prior studies have not consistently considered confounding due to mobility status after TKA, available caregiver support, and measures of home area deprivation. The purpose of this study was to examine 30-day and 90-day readmission risk for patients discharged to a skilled nursing facility (SNF) following TKA after controlling specifically for these factors, among other covariates. METHODS: This was a retrospective cohort study of patients undergoing TKA at any of 11 hospitals in a single, large, academic health-care system between January 2, 2017, and August 31, 2022, who were discharged to an SNF or home health care (HHC). The adjusted relative risk of readmission within 30 and 90 days of discharge to an SNF compared with HHC was estimated using modified Poisson regression models. RESULTS: There were 15,212 patients discharged to HHC and 1,721 patients discharged to SNFs. Readmission within 30 days was 7.1% among patients discharged to SNFs and 2.4% among patients discharged to HHC; readmission within 90 days was 12.1% for the SNF group and 4.8% for the HHC group. The adjusted relative risk after discharge to an SNF was 1.07 (95% confidence interval [CI], 0.79 to 1.46; p = 0.65) for 30-day readmission and 1.45 (95% CI, 1.16 to 1.82; p < 0.01) for 90-day readmission. CONCLUSIONS: Discharge to an SNF compared with HHC was independently associated with 90-day readmission, but not with 30-day readmission, after controlling for mobility status after TKA, available caregiver support, and home Area Deprivation Index, among other covariates. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Johnson et al. (2023) conducted a cohort in Total knee arthroplasty (n=16,933). Discharge to a skilled nursing facility vs. Discharge to home health care was evaluated on 90-day hospital readmission (RR 1.45, 95% CI 1.16 to 1.82, p=<0.01). Discharge to a skilled nursing facility after total knee arthroplasty was associated with a higher risk of 90-day readmission compared to home health care (RR 1.45; 95% CI 1.16-1.82; p<0.01).
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