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FOTO Rehab Outcomes Blog

Discharge Setting after Total Knee Arthroplasty and Complications

I'm not a queen of statistics, so I'm actually confused. It seems the individuals who are discharged from inpatient to a skilled nursing facility are already quite different than individuals who are discharged to a home setting. I don't understand how the difference between the two groups can be negated. Just based on common sense, individuals who are less healthy, will have more complications. It isn't surprising that individuals who are discharged to a skilled nursing facility would have more complications. Then... another little thought enters into my head. Could the complications be a result of poorer care? Some of the complications could be a result of lack of handwashing or lack of movement. 

This study could be interpreted as "skip skilled nursing facilities" for better outcomes. I think it actually has me ask additional questions. 

Here's a quick view of the abstract. 


Continued Inpatient Care After Primary Total Knee Arthroplasty Increases 30-Day Post-Discharge Complications: A Propensity Score-Adjusted Analysis



Discharge destination, either home or skilled care facility, after total knee arthroplasty (TKA) may be associated with significant variation in post-acute care outcomes. The purpose of this study was to characterize the 30-day post-discharge outcomes after primary TKA relative to discharge destination.


All primary unilateral TKAs performed for osteoarthritis from 2011-2014 were identified in the National Surgical Quality Improvement Program database. Propensity scores based on pre-discharge characteristics were used to adjust for selection bias in discharge destination. Propensity-adjusted multivariable logistic regressions were used to examine associations between discharge destination and post-discharge complications.


Among 101,256 primary TKAs identified, 70,628 were discharged home and 30,628 to skilled care facilities. Patients discharged to facilities were more frequently were female, older, higher body mass index class, higher Charlson comorbidity index and American Society of Anesthesiologists scores, had pre-discharge complications, received general anesthesia, and classified as non-independent preoperatively. Propensity adjustment accounted for this selection bias. Patients discharged to skilled care facilities after TKA had higher odds of any major complication (odds ratio [OR]=1.25; 95% confidence interval [CI], 1.13-1.37) and readmission (OR=1.81; 95% CI, 1.50-2.18). Skilled care was associated with increased odds for respiratory, septic, thromboembolic and urinary complications. Associations with death, cardiac and wound complications were not significant.


After controlling for pre-discharge characteristics, discharge to skilled care facilities versus home after primary TKA is associated with higher odds of numerous complications and unplanned readmission. These results support coordination of care pathways to facilitate home discharge after hospitalization for TKA whenever possible.