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, 2 (10), e1914259

Association of Race/Ethnicity With Hospital Discharge Disposition After Elective Total Knee Arthroplasty

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Association of Race/Ethnicity With Hospital Discharge Disposition After Elective Total Knee Arthroplasty

Jasvinder A Singh et al. JAMA Netw Open.

Erratum in

  • Error in Author Affiliations.
    JAMA Netw Open. 2019 Dec 2;2(12):e1918528. doi: 10.1001/jamanetworkopen.2019.18528. JAMA Netw Open. 2019. PMID: 31800065 Free PMC article. No abstract available.

Abstract

Importance: Total knee arthroplasty (TKA) is one of the most common elective procedures performed in adults with end-stage arthritis. Racial disparities in TKA outcomes have been described in the literature.

Objectives: To assess the association of race/ethnicity with discharge disposition and hospital readmission after elective primary TKA and to assess the association of nonhome discharge disposition with hospital readmission risk.

Design, setting, and participants: This retrospective cohort study used data from the Pennsylvania Health Care Cost Containment Council Database, a large regional database that included demographic data from all discharges of patients who underwent elective primary TKA in 170 nongovernmental acute care hospitals in Pennsylvania from April 1, 2012, to September 30, 2015. Data analyses were conducted from September 29, 2017, to November 29, 2017.

Exposures: Patient race/ethnicity and discharge disposition.

Main outcomes and measures: Discharge disposition and 90-day hospital readmission.

Results: Among 107 768 patients, 7287 (6.8%) were African American, 68 372 (63.4%) were women, 46 420 (43.1%) were younger than 65 years, and 60 636 (56.3%) were insured by Medicare. In multivariable logistic regression, among patients younger than 65 years, African American patients were more likely than white patients to be discharged to inpatient rehabilitation facility (IRF) (adjusted relative risk ratio [aRRR], 2.49 [95% CI, 1.42-4.36]; P = .001) or a skilled nursing facility (SNF) (aRRR, 3.91 [95% CI, 2.17-7.06]; P < .001) and had higher odds of 90-day hospital readmission (adjusted odds ratio [aOR], 1.30 [95% CI, 1.02-1.67]; P = .04). Compared with white patients 65 years or older, African American patients 65 years or older were more likely to be discharged to SNF (aRRR, 3.30 [95% CI, 1.81-6.02]; P < .001). In both age groups, discharge to an IRF (age <65 years: aOR, 3.62 [95% CI, 2.33-5.64]; P < .001; age ≥65 years: aOR, 2.85 [95% CI, 2.25-3.61]; P < .001) or SNF (age <65 years: aOR, 1.91 [95% CI, 1.37-2.65]; P < .001; age ≥65 years: aOR, 1.55 [95% CI, 1.27-1.89]; P < .001) was associated with higher odds of 90-day readmission.

Conclusions and relevance: This cohort study found that race/ethnicity was associated with higher odds of discharge to an IRF or SNF for postoperative care after primary TKA. Among patients younger than 65 years, African American patients were more likely than white patients to be readmitted to the hospital within 90 days. Discharge to an IRF or SNF for postoperative care and rehabilitation was also associated with a higher risk of readmission to an acute care hospital.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Singh reported receiving personal fees from Crealta/Horizon, Medisys, Fidia, UBM, Medscape, WebMD, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Spherix, the National Institutes of Health, and the American College of Rheumatology; owning stock in Amarin and Viking Therapeutics; serving as a member of the executive committee of Outcome Measures in Rheumatology, on the US Food and Drug Administration Arthritis Advisory Committee, as a member of the US Department of Veterans Affairs Rheumatology Field Advisory Committee, as editor and director of the University of Alabama at Birmingham Cochrane Musculoskeletal Group Satellite Center on Network Meta-Analysis; and having previously served as a member of the Annual Meeting Planning Committee, Quality of Care Committee, Meet-the-Professor, Workshop and Study Group Subcommittee, and Criteria and Response Criteria subcommittee for the American College of Rheumatology outside the submitted work. Dr Parks reported receiving personal fees from Zimmer Biomet outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Rates Discharge Destination After Total Knee Arthroplasty Over Time Stratified by Patient Race/Ethnicity and Age Group
HHC indicates home health care, HSC, home self-care; IRF, inpatient rehabilitation facility; and SNF, skilled nursing facility.
Figure 2.
Figure 2.. Association of African American Race/Ethnicity With Discharge Destination After Total Knee Arthroplasty
Adjusted relative risk ratios (aRRRs) were calculated with white patients as the reference category and adjusted for age, gender, insurance type, comorbidities, metropolitan area location, hospital annual total knee arthroplasty volume, and comorbidities (except peptic ulcer disease, and solid tumor without metastasis in patients aged <65 years and prosthetic device complication, liver disease, metastatic cancer, solid tumor without metastasis, and unhealthy alcohol use in patients aged ≥65years because these variables had P values >.10). Squares indicate point estimates; bars, 95% CI.
Figure 3.
Figure 3.. Association of Discharge Destination With Hospital Readmission Within 90 Days Stratified by Age
Adjusted odds ratios (aORs) were calculated with home self-care as the reference category and adjusted for age, sex, insurance type, comorbidities, metropolitan area location, hospital annual total knee arthroplasty volume, and comorbidities (except for female sex, metropolitan area location, total knee arthroplasty volume by quarter, postoperative myocardial infarction, valvular disease, hypothyroid disease, and peptic ulcer disease in patients aged <65 years and total knee arthroplasty volume by quarter, prosthetic device complication, hypertension, hypothyroid disease, and solid tumor without metastasis in patients aged ≥65 years because these variables had P values >.10). Squares indicate point estimates; bars, 95% CI.

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  • Error in Author Affiliations.
    JAMA Netw Open. 2019 Dec 2;2(12):e1918528. doi: 10.1001/jamanetworkopen.2019.18528. JAMA Netw Open. 2019. PMID: 31800065 Free PMC article. No abstract available.

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