title: Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis.
abstract: Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care.
  
  
  
  Patients discharged home after elective primary THA/TKA from 2011 to 2014 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were performed using perioperative variables.
  
  
  
  A total of 50,376 and 71,293 home-discharged THA and TKA patients were included for analysis, of which, 1575 THA (3.1%) and 2490 TKA (3.5%) patients suffered postdischarge severe complications or unplanned readmissions. These patients were older, smokers, obese, and functionally dependent (P < .001 for all). In multivariate analysis, severe adverse event predischarge, age, male gender, functional status, and 10 other variables were all associated with ≥1.22 odds of postdischarge severe adverse event or readmission (P < .05). THA and TKA patients with 2, 3, or ≥4 risk factors had 1.43-5.06 times odds of complications within 14 days post discharge and 1.41-3.68 times odds of complications beyond 14 days compared to those with 0 risk factors (P < .001 for all).
  
  
  
  Risk factors can be used to predict which home-discharged TJA patients are at greatest risk of postdischarge complications. Given that this is a growing population, we recommend the development of formal risk-stratification protocols for home-discharged TJA patients.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Dong-Han
authors.initials: DH
authors.lastname: Yao
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: Chirag K
authors.initials: CK
authors.lastname: Shah
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, New York.
authors.forename: Alex
authors.initials: A
authors.lastname: Sher
authors.affiliation: Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas.
authors.forename: Karl M
authors.initials: KM
authors.lastname: Koenig
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*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005163:Factor Analysis, Statistical; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000209:etiology; D010351:Patient Discharge; D058996:Quality Improvement; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
keywords: home discharge; home health; postdischarge complications; primary total joint arthroplasty; risk stratification; unplanned readmission