Effect of Posthospital Syndrome on Discharge Disposition and Healthcare Utilization After Primary Total Joint Arthroplasty

The aim of this study is to evaluate the impact of posthospital syndrome (PHS), a physiologically deconditioned state experienced by patients after hospitalizations, on postoperative healthcare utilization and discharge disposition following total hip (THA) and knee (TKA) arthroplasty.

Insurance claims from the Truven MarketScan Databases were used to perform this cross-sectional study of patients who underwent unilateral, primary THA or TKA between January 2010 and December 2016. PHS, defined as a hospitalization within 90 days before surgery, and non-PHS cohorts were compared. Multivariable logistic regression analyses were used to identify risk of postoperative discharge to an extended care facility (ECF), hospital readmissions, and emergency department visits within 90 days.

This study included 115,465 THA and 190,398 TKA patients who underwent elective surgery for osteoarthritis. PHS was identified in 1.9% and 1.6% of cohorts, respectively, and was more common in patients with higher comorbidities. The PHS cohort had higher crude rates of discharge to ECF (THA 38.8% and TKA 33.8%) and readmissions (21.8% and 18%). Adjusted odds ratios showed that PHS increased risk of disposition to ECF (THA 1.9 and TKA 1.4), readmission (2.8 and 2.0), and emergency department encounters (1.6 and 1.4). Among PHS patients, acute hospitalizations within 30 days of surgery and those lasting greater than 5 days had the highest risk of postoperative healthcare utilization.

In this study of commercially insured patients, those with an acute hospitalization within 90 days before elective total joint arthroplasty were nearly twice as likely to be discharged to an ECF and twice as likely to be readmitted in the global postoperative period.