Discharge to the skilled nursing facility: patient risk factors and perioperative outcomes after total knee arthroplasty

AbstractThere are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p ≤ 0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p ≤ 0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.

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The Effect of Medicare’s Bundled Payments for Care Initiative on Patient Risk Factors Prior to Total Knee Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.12.031 ◽

2020 ◽

Author(s):

Oren Feder ◽

Mackenzie A. Roof ◽

Shengnan Huang ◽

Matthew S. Galetta ◽

Lorraine Hutzler ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Patient Risk ◽

Bundled Payments ◽

Total Knee

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Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns

Journal of Orthopaedic Surgery ◽

10.1177/2309499020918170 ◽

2020 ◽

Vol 28 (2) ◽

pp. 230949902091817

Author(s):

Nicholas M. Hernandez ◽

Sean P. Ryan ◽

Christine J. Wu ◽

Zoe W. Hinton ◽

Samuel S. Wellman ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Skilled Nursing Facility ◽

Bilateral Total Knee Arthroplasty ◽

Skilled Nursing ◽

Tertiary Referral Center ◽

Bilateral Tkas ◽

Total Knee ◽

Ed Visits ◽

Acute Care Facilities

Purpose: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to compare patient outcomes at a single tertiary referral center. Methods: The institutional database was queried from March 2014 to December 2017 for primary TKA. Patients undergoing bilateral procedures were stratified by same-day versus staged; length of stay (LOS), disposition, 90-day emergency department (ED) visits, and 90-day readmissions were examined through univariable and multivariable analyses. Results: A total of 676 patients were evaluated (113 same-day and 563 staged bilateral TKA patients) with mean age 66.0 (8.5) at first surgery and 292.1 (241.6) days between staged procedures. Same-day bilateral TKA patients were younger ( p < 0.001), had lower body mass index (BMI) ( p = 0.010), and had lower American Society of Anesthesiologists (ASA) scores ( p = 0.030). They were more likely to have a prolonged LOS ( p < 0.001) and be discharged to skilled nursing facility or rehab facility ( p < 0.001). Total LOS for separate hospitalizations in staged procedures was greater than LOS for same-day bilateral TKAs ( p < 0.001). There was no difference in 90-day ED visits ( p = 0.623) or readmission ( p = 0.286). In a multivariable model controlling for age, BMI, and ASA score, same-day bilateral TKA was not significantly associated with ED visits or readmissions. Conclusions: Patients undergoing same-day bilateral TKAs were more likely to be discharged to post-acute care facilities, however they did not have increased 90-day readmissions.

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Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0038-1636908 ◽

2018 ◽

Vol 32 (01) ◽

pp. 111-116 ◽

Cited By ~ 4

Author(s):

John Barrington ◽

Ryan Hansen ◽

Belinda Lovelace ◽

Elaine Böing ◽

Morad Chughtai ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Side Effects ◽

Postoperative Pain ◽

Knee Arthroplasty ◽

Skilled Nursing Facility ◽

Skilled Nursing ◽

Discharge Disposition ◽

Lengths Of Stay ◽

Oral Group ◽

Total Knee

AbstractPostoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.

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Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2020.5060 ◽

2020 ◽

Author(s):

Ryan D'Souza ◽

Christopher Duncan ◽

Daniel Whiting ◽

Michael Brown ◽

Matthew Warner ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Length Of Stay ◽

Hospital Cost ◽

Skilled Nursing Facility ◽

Hospital Length ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Nursing Facility ◽

Skilled Nursing ◽

Total Knee

Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p<0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p=0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient -0.582, 95% CI -1.008– -0.156, p=0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p=0.023) and reduced total hospital cost of care by 6.45% (p<0.001), room and board costs by 11.76% (p<0.001), and transfusion costs by 81.65% (p<0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.

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A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.220 ◽

2015 ◽

Vol 36 (12) ◽

pp. 1409-1416 ◽

Cited By ~ 23

Author(s):

Sara Y. Tartof ◽

Gunter K. Rieg ◽

Rong Wei ◽

Hung Fu Tseng ◽

Steven J. Jacobsen ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Southern California ◽

Skilled Nursing Facility ◽

Antibiotic Exposure ◽

Kaiser Permanente ◽

Nursing Facility ◽

Skilled Nursing ◽

Transfer Factors ◽

Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

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