A new study published in the Journal of Bone and Joint Surgery examines total joint replacements among the Medicare population.
The study authors examined 2008 Medicare Provider Analysis and Review database 100 percent sample for patients who underwent elective total hip or knee replacements. There were 138,842 patients who underwent total hip arthroplasties and 329,233 patients who underwent total knee arthroplasties.
Here are seven key findings from the study:
1. The discharge location for total hip arthroplasty patients was:
• Home: 18 percent
• Home health care: 34 percent
• Extended-care facilities: 35 percent
• Inpatient rehabilitation: 13 percent
2. The discharge location for total knee replacement patients was:
• Home: 21 percent
• Home health care: 38 percent
• Extended-care facilities: 31 percent
• Inpatient rehabilitation: 10 percent
3. Location also played a role in where patients were likely to go after discharge; those in the Northeast were more likely to be discharged to extended care facilities or inpatient rehabilitation.
4. In the western part of the country, patients reported the highest charges for the 90-day episode of care. Being discharged to inpatient rehabilitation was also associated with higher charges.
5. After their stay in extended care facilities, about 70 percent of the patients were discharged home. On the other hand, more than 50 percent of the patients who were discharged to inpatient rehabilitation later received home health care.
6. Readmission rates for patients who were discharged home were highest in the South — 9.6 percent — among total hip replacement patients; the readmission rates for total knee replacement patients were highest in the Midwest at 8.7 percent and South at 8.5 percent.
7. The factors associated with readmissions included:
• Having four or more comorbidities
• Discharge to inpatient rehabilitation
• Discharge to extended care facilities