Do non-medical factors affect a patients decision to go home or to rehab after total joint arthroplasty

Studies have shown that patients who go home after a total hip or knee replacement report higher satisfaction, better overall outcomes, and it also saves the hospitals money.  Some people would say that the better outcomes occur because the patients healthy enough to go home are set up to do better (its a selected population, and not related to actually going home).  Therefore, you cannot generalize about what is best for "patients" as a whole, however, you can look at all the variables that determine where people go after surgery and then use that information to help guide where you will go after your total hip or total knee replacement.

Here are a few things that have been shown to affect where people go after their surgery: ethnicity, gender, age, living arrangements, insurance status, expectations, and postop length of hospital stay.  

One recent study found the following variables associated with increased likelihood of going to a rehab center after a joint replacment: female gender, total knee replacement (vs. total hip), lower-to-mid social economic status, black ethnicity, advanced age (>70 years old).  

Theres findings have been demonstrated in other studies as well.  In general lower socioeconomic status is associated with worse outcomes after joint arthroplasty, probably because of less access to physical therapy and assistance after surgery.  Female gender was the most important predictor, with almost twice as many going to a rehab facility. Black ethnicity was associated with discharge location in only one other study, and in this recent study, once medical insurance and age were accounted for in the analysis, ethnicity no longer played a significant role. 

It is therefore important for patients and surgeons to recognize some of these proposed variables which helps to predict where patients are likely to go after surgery.  This helps with postoperative planning for patients and family members.  

Reference.

1. R. Iorio. Strategies and tactics for successful implementation of bundled payments: bundled payment for care improvement at a large, urban, academic medical center. J Arthroplasty, 30 (3) (2015). full article. 

2. A. Keswani, M.C. Tasi, A. Fields, et al. Discharge destination after total joint arthroplasty: an analysis of post-discharge outcomes, placement risk factors, and recent trends. J Arthroplasty, 31 (6) (2016), p. 1 5. full article.

3. M.C. Munin, K. Kwoh, N. Glynn, et al. Predicting discharge outcome after elective hip and knee arthroplasty. Am J Phys Med Rehabil, 74 (1995), p. 294. full article.  relates age, comorbidities, living alone with higher rate of rehab placement. 

4. N. Morrow-Howell, E. Proctor. Discharge destinations of Medicare patients receiving discharge planning: who goes where? Med Care, 32 (5) (1994), p. 486. full article.

5. M.J. Halawi, T.J. Vovos, C.L. Green, et al. Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty J Arthroplasty, 30 (2015), p. 359. full article.

6. B. Sharareh, N.B. Le, M.T. Hoang, et al. Factors determining discharge destination for patients undergoing total joint arthroplasty J Arthroplasty, 29 (2014), p. 1355. full article.

7.  P. de Pablo, E. Losina, C.B. Phillips, et al. Determinants of discharge destination following elective total hip replacement. Arthritis Rheum, 51 (6) (2004), p. 1009. full article. age, living alone, and obesity is signfiicant in going to rehab. 

8. K.J. Bozic, A. Wagie, J.M. Naessens, et al. Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplasty, 21 (6 Suppl 2) (2006), p. 151. full article. age is important factor. 

9. W.K. Barsoum, T.G. Murray, A.K. Klika, et al. Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty, 25 (6) (2010), p. 885. full article.

10.  I.A. Inneh, J. Slover, J.A. Bosco, et al. Role of sociodemographic, co-morbid and intraoperative factors in length of stay following primary total hip replacement. J Arthroplasty, 30 (12) (2015), p. 2092. full article. worse outcome in lower ses.

11. I.A. Inneh. The combined influence of sociodemographic, preoperative comorbid and intraoperative factors on longer length of stay after elective primary total knee arthroplasty. J Arthroplasty, 30 (11) (2015), p. 1883. full article. 

12. C.J. Lavernia, D. Lee, R.J. Sierra, et al. Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients. J Arthroplasty, 19 (8) (2004), p. 978. full article. 

13. B.U. Nwachukwu, A.D. Kenny, E. Losina, et al. Complications for racial and ethnic minority groups after total hip and knee replacement: a review of the literature. J Bone Joint Surg Am, 92 (2) (2010), p. 338. full article. 

14. K.L. Garvin, S. Yu, W.L. Healy, et al. Preventing hospital readmissions and limiting the complications associated with total joint arthroplasty. J Am Acad Orthop Surg, 23 (2015), p. e60. see full article. 

15. Inneh IA et al. Disparities in discharge destination after lower extremity joint arthroplasty: analysis of 7924 patients in an urban setting. J Arthroplasty. 2106. see full article.