Poster 1: Joint Replacement and Hip Fracture Readmission Rates: Impact of Discharge Destination

Article Outline

• Disclosures
• Objective
• Design
• Setting
• Participants
• Main Outcome Measures
• Results
• Conclusions
• Copyright

Keywords: Rehabilitation, Hip fracture, Orthopedics, Patient readmission

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Disclosures 

R. V. Riggs, None.

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Objective 

To determine if discharge destination after hospitalization for hip or knee replacement and hip fracture repair influences the hospital readmission rate.

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Design 

A retrospective cohort design including all patients with primary diagnosis of hip or knee replacement and hip fracture discharged from the acute hospital from 2004-2006.

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Setting 

Urban academic non-profit hospital.

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Participants 

The study analyzed the discharge destination of 819 orthopedic patients discharged from the acute hospital and rate of unplanned readmission to the study site hospital within 180 days. Data pertaining to these patients were abstracted from the University HealthSystem Consortium's (UHC) clinical data base.

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Main Outcome Measures 

Unplanned readmission rates to the study-site hospital within 180 days after discharge from the acute hospital following hip or knee replacement and hip fracture repair.

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Results 

An unplanned readmission rate of 12.5% occurred within 180 days post acute hospital discharge in the study population. When stratified by discharge destination, readmission rates were: home 14.5%, skilled nursing facility 14.3%, and inpatient rehabilitation 7.7%. χ² analysis revealed a lower rate of unplanned 180-day readmission for patients discharged to inpatient rehabilitation (P < .001); as well as increased risk for readmission for two comorbidities, sickle cell (P = .007) and COPD (P = .032). In logistic regression analysis utilizing multiple independent risk factors, discharged to inpatient rehabilitation (P = .001) and sickle cell (P = .002) remained significant predictors.

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Conclusions 

Discharge to inpatient rehabilitation yielded a significantly lower readmission rate than discharge to home or a skilled nursing facility. Only sickle cell disease as a comorbidity demonstrated a higher readmission rate. Identification of patients who may benefit from inpatient rehabilitation and further medical management prior to discharge from the acute hospital may be an important strategy in prevention of hospital readmission.