Skilled Nursing Facility Placement Process After Total Hip and Total Knee Arthroplasty: Revised Rating System and Opportunities for Intervention

2019 ◽  
Vol 34 (6) ◽  
pp. 1066-1071 ◽  
Author(s):  
Daniel J. Snyder ◽  
Thomas R. Kroshus ◽  
Aakash Keswani ◽  
Kevin J. Bozic ◽  
Yale A. Fillingham ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Rating System ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Facility Placement ◽  
Total Knee

scholarly journals Discharge to the skilled nursing facility: patient risk factors and perioperative outcomes after total knee arthroplasty

2019 ◽  
Vol 7 (4) ◽  
pp. 65-65 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Chukwuweike Gwam ◽  
Sergio M. Navarro ◽  
Heather S. Haeberle ◽  
Jaret M. Karnuta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Perioperative Outcomes ◽  
Nursing Facility ◽  
Patient Risk ◽  
Skilled Nursing ◽  
Total Knee

Comparison of Day Rehabilitation to Skilled Nursing Facility for the Rehabilitation for Total Knee Arthroplasty

2013 ◽  
Vol 92 (1) ◽  
pp. 61-67 ◽  
Author(s):  
Bess Kathrins ◽  
Richard Kathrins ◽  
Robert Marsico ◽  
Michael Frank ◽  
Brenda Stevenson-Marshall ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Knee

Total Knee Arthroplasty in Patients with Dementia

2020 ◽  
Author(s):  
Nicholas M. Hernandez ◽  
Daniel J. Cunningham ◽  
William A. Jiranek ◽  
Michael P. Bolognesi ◽  
Thorsten M. Seyler
Keyword(s):  
Emergency Department ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
National Database ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Increased Risk ◽  
Total Knee

AbstractThere are few studies evaluating total knee arthroplasty (TKA) in patients with dementia. The purpose of this study was to evaluate the rate of revision, complication, emergency department (ED) visitation, and discharge disposition in patients with dementia undergoing primary TKA. In this retrospective study, we evaluated patients from 2007 to 2017 using a national database. Ninety-day complications in patients with dementia undergoing TKA were increased risk of ED visitation and skilled nursing facility (SNF) disposition (p  ≤  0.05). Two-year complications in patients with dementia undergoing TKA were increased risk of ED visitation and SNF disposition (p  ≤  0.05). Patients with dementia undergoing TKA are at an increased risk of resource utilization.

scholarly journals Same-day Bilateral Total Knee Arthroplasty Did Not Increase 90-day Hospital Returns

2020 ◽  
Vol 28 (2) ◽  
pp. 230949902091817
Author(s):  
Nicholas M. Hernandez ◽  
Sean P. Ryan ◽  
Christine J. Wu ◽  
Zoe W. Hinton ◽  
Samuel S. Wellman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Bilateral Total Knee Arthroplasty ◽  
Skilled Nursing ◽  
Tertiary Referral Center ◽  
Bilateral Tkas ◽  
Total Knee ◽  
Ed Visits ◽  
Acute Care Facilities

Purpose: Bilateral total knee arthroplasty (TKA) can be performed in patients with bilateral knee arthritis. Outside of nationwide database studies, which have limitations, few studies have compared outcomes for same-day versus staged TKA. We sought to compare patient outcomes at a single tertiary referral center. Methods: The institutional database was queried from March 2014 to December 2017 for primary TKA. Patients undergoing bilateral procedures were stratified by same-day versus staged; length of stay (LOS), disposition, 90-day emergency department (ED) visits, and 90-day readmissions were examined through univariable and multivariable analyses. Results: A total of 676 patients were evaluated (113 same-day and 563 staged bilateral TKA patients) with mean age 66.0 (8.5) at first surgery and 292.1 (241.6) days between staged procedures. Same-day bilateral TKA patients were younger ( p < 0.001), had lower body mass index (BMI) ( p = 0.010), and had lower American Society of Anesthesiologists (ASA) scores ( p = 0.030). They were more likely to have a prolonged LOS ( p < 0.001) and be discharged to skilled nursing facility or rehab facility ( p < 0.001). Total LOS for separate hospitalizations in staged procedures was greater than LOS for same-day bilateral TKAs ( p < 0.001). There was no difference in 90-day ED visits ( p = 0.623) or readmission ( p = 0.286). In a multivariable model controlling for age, BMI, and ASA score, same-day bilateral TKA was not significantly associated with ED visits or readmissions. Conclusions: Patients undergoing same-day bilateral TKAs were more likely to be discharged to post-acute care facilities, however they did not have increased 90-day readmissions.

scholarly journals Improving Orthopedic Care Delivery Through Digital Engagement

Iproceedings ◽  
10.2196/16305 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e16305
Author(s):  
Lisa Biernat ◽  
Carly E Milliren ◽  
Jon Rauen ◽  
Bill Lindsay ◽  
Betsy Weaver ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Hip Replacement ◽  
Skilled Nursing Facility ◽  
Patient Activation ◽  
Hospital Length Of Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Total Knee ◽  
Ed Visits

Background Patient activation has been hypothesized to improve medical and surgical outcomes by increasing patient involvement in the care plan. We tested this hypothesis by utilizing a patient activation tool in a population of adults having total hip or total knee replacement. We hypothesized that patient activation would be associated with increased discharge to home as opposed to a skilled nursing facility, reduced hospital length of stay, decreased inpatient readmissions, and decreased emergency department (ED) visits. Objective Using an email patient activation tool, we sought to increase patients’ involvement in their care before and after total joint replacement. Outcomes examined included day of surgery cancellation, length of hospital stay, discharge to home vs discharge to a skilled nursing facility, any ED visit within 30 days of discharge, and any inpatient readmission within 30 days of discharge Methods This was a quasi-experimental design comparing Jan-Jun 2017 to Jan-Jun 2018. We instituted an email patient activation tool for all patients with total knee or total hip replacement surgery beginning in January 2018. This tool was integrated with the electronic medical record system during the six month study period and patients could opt out at anytime if they desired. The tool was designed to prepare patients both educationally and emotionally for their operation with multiple easy-to-read emails starting from the time they were scheduled for surgery through six months postop. Percent of emails opened and clicked were used as measures of engagement for the intervention participants. Results Of the 2,027 TJR patients included, 720 were hip patients and 1,307 were knee patients. Pre- and postintervention groups were similar in gender and age. For hip replacement patients, length of stay was nearly 1/4 day lower in the postintervention group (β=-0.23; P=.001) after adjusting for gender, age and insurance; ED visits were lower among the postintervention group (OR=0.45; P=.05) after adjusting for gender, age and insurance; and postintervention patients were less likely to have day of surgery cancellation, any revisit (ED or readmission), and were more likely to be discharged home. However, these associations did not reach statistical significance. Conclusions Among patients who received the intervention, higher engagement was significantly associated with positive changes in almost all outcomes. Use of the digital patient activation tool demonstrated significant savings in length of stay and reduced ED visits among hip replacement patients. Although just under 50% of patients in the intervention group were enrolled to use the tool, these findings were still significant even when non-participants were included in the postintervention group.

Postacute Care Disposition for Total Hip and Total Knee Replacement Surgery for Asian Americans

2020 ◽  
Vol 32 (3) ◽  
pp. 156-164
Author(s):  
Grace L. Reynolds ◽  
Dennis G. Fisher
Keyword(s):  
Asian Americans ◽  
Home Health Care ◽  
Skilled Nursing Facility ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Hip ◽  
Replacement Surgery ◽  
Total Knee ◽  
Postacute Care ◽  
Racial Ethnic

This study explored differences in postacute disposition for total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a focus on whether Asian Americans (AS) experience joint replacement disparities observed in other racial/ethnic minorities compared with majority white patients. We used data from the Nationwide Inpatient Sample for 2009 through 2012. We looked at disposition to home health care (HHC) and transfer to another facility for postacute care (e.g., skilled nursing facility, rehabilitation facility) for each of the 4 years under study. Findings for AS were mixed. There were differences in discharge to postacute facilities other than HHC for AS compared with whites for THA for 2011 and 2012. For TKA, there were differences in disposition to HHC for Asians compared with whites for 2009 and 2012; for disposition to postacute facilities other than HHC for TKA, there were differences for 2011 and 2012 only. Differences for AS in postacute disposition to facilities other than HHC appear to increase over the 4 years of the study. Further research with additional data is warranted.

Impact of Intravenous Acetaminophen on Lengths of Stay and Discharge Status after Total Knee Arthroplasty

2018 ◽  
Vol 32 (01) ◽  
pp. 111-116 ◽  
Author(s):  
John Barrington ◽  
Ryan Hansen ◽  
Belinda Lovelace ◽  
Elaine Böing ◽  
Morad Chughtai ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Side Effects ◽  
Postoperative Pain ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition ◽  
Lengths Of Stay ◽  
Oral Group ◽  
Total Knee

AbstractPostoperative pain remains difficult to control after total knee arthroplasty (TKA). While various modalities have been used, they have been associated with several side effects. For example, opioids have many side effects including: sedation, dizziness, nausea, vomiting, constipation, respiratory depression, and can lead to dependency. Recently, intravenous (IV) acetaminophen has been introduced as a method to manage postoperative pain. Therefore, the purpose of this study was to compare the postoperative outcomes of TKA patients who received oral acetaminophen versus IV acetaminophen. Specifically, this study evaluated: (1) the hospital lengths of stay (LOS) and (2) discharge dispositions. The Premier Database was used to review patients who underwent TKA from 2012 to 2015. A total of 134,216 TKA patients received oral acetaminophen, whereas 56,475 TKA patients received IV acetaminophen postoperatively. LOS were calculated as the number of days from the date of hospital admission to the date of discharge, and the discharge disposition was categorized as to home or to a skilled nursing facility (SNF). Compared with the oral group, the IV acetaminophen group had a 0.14 days shorter LOS (95% confidence interval [CI], –0.15 to –0.13; p < 0.001) and 22% higher chance of being discharged home (odds ratio [OR] = 1.22; 95% CI, 1.19–1.25; p < 0.001). Also, compared with the oral group, the IV group had a 13% lower chance of being discharged to a SNF (OR = 0.87; 95% CI, 0.85–0.90; p < 0.001). This study demonstrated that TKA patients who received IV acetaminophen were associated with a significantly shorter hospital LOS as well as being discharged home and fewer patients had to go to SNF. This may lead to a reduction in the total cost of health care, while, at the same time, decreasing the resource use in patients who undergo TKA.

scholarly journals Tranexamic acid is associated with decreased transfusion, hospital length of stay, and hospital cost in simultaneous bilateral total knee arthroplasty

2020 ◽  
Author(s):  
Ryan D'Souza ◽  
Christopher Duncan ◽  
Daniel Whiting ◽  
Michael Brown ◽  
Matthew Warner ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Hospital Cost ◽  
Skilled Nursing Facility ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Total Knee

Tranexamic acid (TXA) reduces blood loss and transfusion rates in unilateral total knee arthroplasty (TKA), but there is limited data regarding its efficacy in bilateral TKA. This study reports the impact TXA has on clinical outcomes and hospital cost of care in simultaneous, primary bilateral TKA. The 449 patients were retrospectively reviewed. Primary outcomes included the rates of allogeneic and autologous blood transfusion. Secondary outcomes included hospital length of stay (HLOS), post-hospital discharge disposition, 30-day thromboembolic events (TEE), and mean hospital cost of care. Total direct medical costs were obtained from an institutional research database and adjusted to nationally representative unit costs in 2013 inflation-adjusted dollars. Our study revealed that in patients undergoing simultaneous bilateral TKA, TXA use was associated with reduced allogeneic (OR 0.181, 95% CI 0.090-0.366, p<0.001) and combined allogeneic and autologous transfusion rates (OR 0.451, 95% CI 0.235-0.865, p=0.017). TXA was associated with a HLOS reduction of 0.9 days (β-coefficient -0.582, 95% CI -1.008– -0.156, p=0.008), an increased likelihood of hospital discharge over skilled nursing facility (SNF) (OR 2.25, 95% CI 1.117-4.531, p=0.023) and reduced total hospital cost of care by 6.45% (p<0.001), room and board costs by 11.76% (p<0.001), and transfusion costs by 81.65% (p<0.001). In conclusion, TXA use in bilateral TKA is associated with lower blood transfusion rates, reduced hospital length of stay, reduced cost of hospital care and skilled nursing facility avoidance.

A Comparative Analysis of Patient Satisfaction following Total Knee Arthroplasty and Total Hip Arthroplasty Using the Forgotten Joint Score

2020 ◽  
Vol 04 (02) ◽  
pp. 084-089
Author(s):  
Vivek Singh ◽  
Stephen Zak ◽  
Ran Schwarzkopf ◽  
Roy Davidovitch
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Demographic Data ◽  
Demographic Differences ◽  
Total Hip ◽  
Forgotten Joint Score ◽  
Total Knee

AbstractMeasuring patient satisfaction and surgical outcomes following total joint arthroplasty remains controversial with most tools failing to account for both surgeon and patient satisfaction in regard to outcomes. The purpose of this study was to use “The Forgotten Joint Score” questionnaire to assess clinical outcomes comparing patients who underwent a total hip arthroplasty (THA) with those who underwent a total knee arthroplasty (TKA). We conducted a retrospective review of patients who underwent primary THA or TKA between September 2016 and September 2019 and responded to the Forgotten Joint Score-12 (FJS-12) questionnaire at least at one of three time periods (3, 12, and 21 months), postoperatively. An electronic patient rehabilitation application was used to administer the questionnaire. Collected variables included demographic data (age, gender, race, body mass index [BMI], and smoking status), length of stay (LOS), and FJS-12 scores. t-test and chi-square were used to determine significance. Linear regression was used to account for demographic differences. A p-value of less than 0.05 was considered statistically significant. Of the 2,359 patients included in this study, 1,469 underwent a THA and 890 underwent a TKA. Demographic differences were observed between the two groups with the TKA group being older, with higher BMI, higher American Society of Anesthesiologists scores, and longer LOS. Accounting for the differences in demographic data, THA patients consistently had higher scores at 3 months (53.72 vs. 24.96; p < 0.001), 12 months (66.00 vs. 43.57; p < 0.001), and 21 months (73.45 vs. 47.22; p < 0.001). FJS-12 scores for patients that underwent THA were significantly higher in comparison to TKA patients at 3, 12, and 21 months postoperatively. Increasing patient age led to a marginal increase in FJS-12 score in both cohorts. With higher FJS-12 scores, patients who underwent THA may experience a more positive evolution with their surgery postoperatively than those who had TKA.

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