title: Discharge Destination After Revision Total Joint Arthroplasty: An Analysis of Postdischarge Outcomes and Placement Risk Factors.
abstract: Given the rising incidence of revision total joint arthroplasty (RJR), bundled payments will likely be applied to RJR in the near future. This study aimed to compare postdischarge adverse events by discharge destination, identify risk factors for discharge placement, and stratify RJR patients based on these risk factors to identify the most appropriate discharge destination.
  
  
  
  Patients that underwent revision total hip or knee arthroplasty from 2011 to 2013 were identified in the American College of Surgeon's National Surgical Quality Improvement Program database. Analysis of risk factors was assessed using preoperative and intraoperative variables.
  
  
  
  A total of 9973 RJR patients from 2011 to 2013 were included for analysis. The most common discharge destination included home (66%), skilled nursing facility (SNF; 23%), and inpatient rehabilitation facility (IRF; 11%). Bivariate analysis revealed higher rate of postdischarge 30-day severe adverse events (6.1% vs 4.1%, P < .001) and unplanned readmissions (9.3% vs 6.1%, P < .001) in nonhome vs home patients. In multivariate analysis, SNF and IRF patients were 1.30 and 1.51 times more likely to suffer an unplanned 30-day readmission relative to home patients (P ≤ .01), respectively. After stratifying patients by number of significant risk factors and discharge destination, IRF patients consistently had significantly higher rates of unplanned 30-day readmission than home patients (P ≤ .05).
  
  
  
  RJR patients who are discharged to SNF or IRF have significantly increased risk for unplanned readmissions as compared with patients discharged home. Across risk levels, home discharge destination (when feasible) is the optimal strategy compared with IRF, although the distinction between SNF and home is less clear.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Aakash
authors.initials: A
authors.lastname: Keswani
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Weiser
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lovy
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Calin S
authors.initials: CS
authors.lastname: Moucha
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D066231:Surgeons
keywords: discharge destination; discharge disposition; inpatient rehab; readmission; revision joint arthroplasty; skilled nursing facility