Abstract
Recently, with the Medicare bundled payments initiative for total knee arthroplasty
(TKA), there has been a move by many institutions to further streamline costs associated
with the entire operative and perioperative process. One of these cost-saving strategies
has been to favor discharging patients to home with outpatient services as opposed
to discharging to the relatively more expensive rehabilitation facilities. Our aim
was to determine the success of a teaching institute's initiative in discharging patients
to home instead of a rehabilitation facility. Specifically, we evaluated if there
were differences in discharge disposition based off of (1) surgeon/patient preference,
(2) length of stay, (3) demographics, and (4) postoperative complications. A retrospective
review of all patients who had a TKA from 2015 to 2017 at a single teaching institution
was performed and assessed discharge to home or to a rehabilitation facility. If they
were not discharged to home, we evaluated why that did not happen, stratified the
reason they were discharged to a rehabilitation facility into four groups based on
(1) physician and occupational health team assessment, (2) patient preference, (3)
physician preference, and (4) family or caretaker preference. A total of 229 patients
were enrolled in this initiative, with 107 patients (47%) discharged to home with
outpatient physical therapy services and 122 (53%) discharged to a rehabilitation
facility. Of these, 35 patients (29%) went to these facilities because of physician
and occupational health team assessment. However, 31 (25%) patients were due to patient
preference, 32 (26%) were because of surgeon's preference, and 24 (20%) were not discharged
to home because of family or caretaker preference. There were no differences in length
of stay, gender, or complication rates between cohorts. Many patients can be safely
discharged to home following TKA at a community teaching institution; however, there
continues to be a strong prejudice by patients, physicians, and caretakers to be discharged
to a rehabilitation facility despite the home discharge initiative.
Keywords
total knee arthroplasty - teaching institution - discharge disposition - home
