Factors Determining Discharge Destination for Patients Undergoing Total Joint Arthroplasty Behnam Sharareh, BSc, Natasha B. Le, BA, Melinda T. Hoang, BSc, Ran Schwarzkopf, MD MSc Department of Orthopaedic Surgery, Joint Replacement Service, University of California, Irvine, School of Medicine, Orange, California abstract article info Article history: Received 2 December 2013 Accepted 1 February 2014 Available online xxxx Keywords: skilled nursing facilities post-operative care discharge destination length of stay physical therapy Discharge destination to skilled nursing facilities (SNF) following total joint arthroplasty (TJA) plays an important role in healthcare costs. The pre-operative, intra-operative, and post-operative factors of 50 consecutive patients discharged to an SNF following TJA were compared to that of 50 consecutive patients discharged to home. Patients discharged to SNFs had slower pre-operative Get Up and Go scores (TGUG), lower pre-operative EQ-5D scores, higher ASA scores, increased hospital length of stay, increased self- reported post-operative pain, and decreased physical therapy achievements. We believe that the results of this study indicate that patients who get discharged to SNFs fit a certain criteria and this may be used to guide post-operative discharge destination during pre-operative planning, which can help lower costs while helping decrease the length of inpatient stay. © 2014 Elsevier Inc. All rights reserved. With the aging population, increasing rates of obesity, and increasing prevalence of osteoarthritis, there is a growing demand for lower-limb joint arthroplasty [1]. Total knee (TKA) and total hip (THA) arthroplasty have shown to be effective in alleviating lower- extremity pain and restoring joint function in those who elect to undergo the procedure. While systemic disease, obesity rates and age, play roles in determining long-term outcomes, proper post- operative care and physical therapy following surgery is instrumen- tal in allowing a patient to return to his daily activities and active lifestyle [2,3]. Following total joint arthroplasty (TJA), patients are generally admitted to the hospital until they have systemic stability and have achieved certain physical therapy milestones. Upon discharge, patients are either sent to their respective homes or to an extended care facility such as a skilled nursing facility (SNF). While such facilities have the benefits of direct patient care and sustained physical therapy, it is estimated that $1.82 billion is spent annually on rehabilitation at such facilities after lower-extremity arthroplasty [4–6]. The average Medicare reimbursement in South- ern California for SNF therapy is $500 per day on weekdays and $300 per day on weekends (since physical therapy is not performed on weekends). Thus a 1-week stay at an SNF will cost $3100. On the contrary, the average Medicare reimbursement for home-health physical therapy and outpatient physical therapy is $158 per day and $210 per day, respectively, which sums to $474 and $610, respectively per week (total joint protocol requires 3 days of PT per week), Furthermore, inpatient hospital stay following surgery can vary in length depending on patient progress prior to discharge and this further places a burden on the cost of post-operative care. It is thus important to determine which factors influence discharge to SNFs and if such factors can be used to minimize unnecessary long- term post-operative hospital stay or SNF discharge as well as assist in pre-operative planning. In this study, a cross-sectional analysis of pre-operative, intra- operative and post-operative factors of a consecutive patient cohort who have undergone total knee and hip arthroplasty was performed to determine which, if any, of these factors play a crucial role in determining discharge destination. Methods After approval by our institutional review board (IRB) was obtained, a retrospective review of the medical files of patients who underwent total hip and total knee arthroplasty from October 2012 through June 2013 was performed. Patients were broken down into two groups based on discharge destination following total joint arthroplasty. The first 50 consecutive patients who were discharged to a skilled nursing facility (SNF) were deemed the SNF-group. The first 50 consecutive patients who were discharged to home were deemed the home-group. As per our protocol, patients who were discharged home had home-health physical therapy arranged for them unless they did not receive approval for such from their insurance (2 of the 50 patients were denied home-health PT and underwent outpatient PT). Discharge instructions and physical therapy goals are discussed with patients during a mandatory pre-operative total joint arthro- plasty class that is offered at our institution. The Journal of Arthroplasty xxx (2014) xxx–xxx Supplementary material available at www.arthroplastyjournal.org. The Conflict of Interest statement associated with this article can be found at http:// dx.doi.org/10.1016/j.arth.2014.02.001. Reprint request. Ran Schwarzkopf, MD MSc, Department of Orthopaedic Surgery, University of California, Irvine, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92868. 0883-5403/0000-0000$36.00/0 – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.arth.2014.02.001 Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org Please cite this article as: Sharareh B, et al, Factors Determining Discharge Destination for Patients Undergoing Total Joint Arthroplasty, J Arthroplasty (2014), http://dx.doi.org/10.1016/j.arth.2014.02.001