Preoperative risk factors for discharge to a postacute care facility after shoulder arthroplasty

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• 作者：Lakshmanan Sivasundaram ; BS ; ^{sivasund@usc.edu" class="auth_mail" title="E-mail the corresponding author} ; Nathanael Heckmann ; MD ; William C. Pannell ; MD ; Ram K. Alluri ; MD ; Reza Omid ; MD ; George F. &ldquo ; Rick&rdquo ; Hatch III ; MD
• 关键词：Level III ; Retrospective Cohort Study using Large Database ; Treatment Study
• 刊名：Journal of Shoulder and Elbow Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：25
• 期：2
• 页码：201-206
• 全文大小：176 K

文摘

Shoulder arthroplasty procedures are becoming increasingly prevalent in the United States due to expanding indications and an aging population. Most patients are discharged home, but a subset of patients is discharged to a postacute care (PAC) facility. The purpose of this study was to identify the risk factors for discharge to a PAC facility after shoulder arthroplasty.

Methods

The Nationwide Inpatient Sample discharge records from 2011 to 2012 were analyzed for patients who underwent a total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). Patient and hospital characteristics were identified. Univariate and multivariate analysis were used to determine the statistically significant risk factors for discharge to a PAC facility while controlling for covariates.

Results

In 2011 and 2012, 103,798 patients underwent shoulder arthroplasty procedures: 58,937 TSAs and 44,893 RTSAs were identified. RTSA patients were 1.3 times as likely to be discharged to a PAC facility as TSA patients (P = .001). Medicare patients were 2 times as likely to be discharged to a PAC facility than those with private insurance (P < .001). In addition, women and patients presenting with a fracture, older age, or an increasing number of medical comorbidities were more likely to be discharged to a PAC facility (P < .001).

Conclusion

The risk factors identified in our study can be used to stratify patients at high risk for postoperative discharge to PAC, allowing for greater improvement in overall care and the facilitation of postoperative discharge planning.