title: The Effect of Comorbidities on Discharge Disposition and Readmission for Total Joint Arthroplasty Patients.
abstract: As the annual demand and number of total joint arthroplasty cases increase, so do concerns of outcomes of patient with specific comorbidities relative to outcomes and costs of care.
  
  
  
  The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty patients. Discharge disposition was classified as discharge to any facility or home. The comorbidities of the patients who were readmitted and those without a 90-day event were also evaluated.
  
  
  
  In the TKA population, age, female gender, nonsmoking status, venous thromboembolism (VTE) history, and diabetes were significantly associated with discharge to extended care facility (ECF) on univariate analysis, unlike body mass index. With multivariate analyses, female gender, age, VTE history, and diabetes were associated with ECF placement, but smoking was not. In the total hip arthroplasty population, age, female gender, and nonsmoking status were significantly associated with discharge to ECF on univariate analysis, whereas body mass index, diabetes, and VTE history were not. On multivariate analyses, female gender and age were associated with ECF, but smoking was not. The only significant finding for the readmission data was an increased rate of readmission for TKA patients of older age.
  
  
  
  The potential of projecting patient discharge and readmission allows physicians to counsel patients and improve patient expectations.
authors.affiliation: Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
authors.forename: Jakub
authors.initials: J
authors.lastname: Sikora-Klak
authors.affiliation: Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
authors.forename: Bradley
authors.initials: B
authors.lastname: Zarling
authors.affiliation: Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bergum
authors.affiliation: Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Flynn
authors.affiliation: Department of Orthopaedic Research, Providence-Providence Park Hospital, Southfield, Michigan; Department of Orthopaedics, The CORE Institute, Southfield, Michigan.
authors.forename: David C
authors.initials: DC
authors.lastname: Markel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012866:Skilled Nursing Facilities; D054556:Venous Thromboembolism / Q000453:epidemiology*
keywords: comorbidities; discharge disposition; hip arthroplasty; knee arthroplasty; prospective; readmission