Examination of discharge settings and readmission rates following hospitalization for total knee arthroplasty

Abstract

Total knee arthroplasty (TKA) is one of the most common surgical procedures performed in the United States with tremendous growth expected. Reducing unplanned hospital readmissions has become a focal point in minimizing healthcare cost within the Medicare population through several initiatives within the Patient Protection and Affordable Care Act (PPACA). Policy changes have also impacted the availability of post-acute care following TKA. Medicare’s 75% rule effectively limits the number of patients with unilateral TKA discharged to inpatient rehabilitation facilities (IRFs). The other two common post-acute settings include skilled nursing facilities (SNFs) and home- and community-based rehabilitation. We used Medicare data from beneficiaries who received TKA to examine 1) time trends in hospital discharge settings and 30-day readmission rates by discharge setting, 2) predictors of hospital discharge setting, and 3) factors associated with 30-day and 90-day readmission rates and reasons for readmission following TKA. We showed that IRF discharge decreased approximately 20% from 2002 to 2010 making it the least utilized post-acute setting. In addition, trends in 30-day readmission rates were lowest in community discharge and relatively the same in SNF and IRF in all study years. Using IRF discharge as the reference, patients who received a bilateral procedure had lower odds of both SNF and community discharge; patients with more comorbidity had lower odds for community discharge and higher odds for SNF discharge; and patients who received their TKA from hospitals with lower TKA volumes had lower odds of SNF and community discharge. Patients that discharged to either SNF or IRF had greater likelihood of 30-day readmission and greater risk for 90-day readmission versus patients discharged to the community. We found similar reasons for readmission from each discharge setting and time period. This study examines the topic of discharge settings and their effect on unplanned hospital readmission following TKA. These findings provide new information to the growing knowledge base on post-acute utilization patterns and hospital readmission rates among older adults receiving TKA.