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Which Patients Require Unexpected Admission to Postacute Care Facilities After Total Hip Arthroplasty?

Tan, Timothy L. MD; Rondon, Alexander J. MD, MBA; Greenky, Max R. MD; Shohat, Noam MD; Goswami, Karan MD; Purtill, James J. MD

Journal of the American Academy of Orthopaedic Surgeons: October 29, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00272
Research Article: PDF Only

Background: Many surgeons prefer to discharge patients home due to patient preferences, improved outcomes, and decreased costs. Despite an institutional protocol to send total hip arthroplasty (THA) patients home, some patients still required postacute care (PAC) facilities. This study aimed to create two predictive models based on preoperative and postoperative risk factors to identify which patients require PAC facilities.

Methods: A retrospective review of 2,372 patients undergoing primary unilateral THA at a single institution from 2012 to 2017 was done. An electronic query followed by manual review identified discharge disposition, demographic factors, comorbidities, and other patient factors. Of the 2,372 patients, 6.2% were discharged to skilled nursing facilities or inpatient rehabilitation facilities and 93.8% discharged home. Univariate and multivariate analysis were conducted to create two predictive models for patient discharge: preoperative visit and postoperative hospital course.

Results: Of 45 variables evaluated, 7 were found to be notable predictors for PAC facility discharge. In descending order, these included age 65 years or greater, non-Caucasian race, history of depression, female sex, and greater comorbidities. In addition to preoperative factors, in-hospital complications and surgical duration of 90 minutes or greater led to a higher likelihood of PAC facility discharge. Both models had excellent predictive assessments with area under curve values of 0.77 and 0.80 for the preoperative visit and postoperative models, respectively.

Discussion: This study identifies both preoperative and postoperative risk factors that predispose patients to nonroutine discharges after THA. Orthopaedic surgeons may use these models to better predict which patients are predisposed to discharge to PAC facilities.

From the Rothman Institute at Thomas Jefferson University, Philadelphia, PA (Dr. Tan, Dr. Rondon, Dr. Greenky, Dr. Shohat, Dr. Goswami, Dr. Purtill), and the Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel (Dr. Shohat).

Correspondence to Dr. Rondon:

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Tan, Dr. Rondon, Dr. Greenky, Dr. Shohat, Dr. Goswami, and Dr. Purtill.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 by American Academy of Orthopaedic Surgeons
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