PREDICTING DISCHARGE OUTCOME AFTER ELECTIVE HIP AND KNEE ARTHROPLASTY

The objective of this prospective study was to determine if difference s exist between individuals who require an inpatient rehabilitation pr ogram after elective hip and knee arthroplasty from those patients who can be discharged directly home. Multiple variables consisting of bas eline demographics, social status, insurance status, medical history, pain level, quantitative strength, range of motion, and functional abi lity were examined. The primary outcome measure was the discharge dest ination from the orthopedic service and consisted of either a discharg e to home or a discharge to an inpatient rehabilitation unit. Of the 1 62 patients followed, 65 (40%) were discharged to an inpatient rehabil itation unit, whereas 97 were discharged to home. The patients dischar ged to inpatient rehabilitation tended to live alone, were significant ly older (mean difference = 6.3 yr), and had increased comorbid condit ions (P < 0.001 for all variables). Patients discharged to a rehabilit ation unit reported significantly greater pain levels than those disch arged to home (P < 0.001). The attainment of a supervision level of fu nction demonstrated greater differences between groups than the attain ment of independent function for all functional measures. A logistic r egression model was developed that predicted 76% of the discharges to rehabilitation by the third physical therapy session postsurgery. In c onclusion, predictive markers do exist that differentiate individuals who require further inpatient therapy services after joint replacement surgery.