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Postoperative functioning, age, obesity, and social support influence where patients go after total hip replacement

Individuals who undergo total hip replacement (THR), most often for advanced hip osteoarthritis, usually gain substantial pain relief and improved functioning. Following THR, patients who are older, obese, living alone, or unable to walk at discharge are more likely to be discharged to an inpatient rehabilitation facility than directly to home, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09775). These factors must be considered in efforts to optimize and streamline discharge planning for THR patients, note the researchers.

To identify factors associated with discharge to an inpatient rehabilitation facility versus discharge directly to home after elective THR, the researchers analyzed data from a medical record review and survey of Medicare patients aged 65 to 94 who underwent elective primary or revision THR in 1995. Over half (58 percent) of the 1,276 patients were discharged from the acute care hospital to a rehabilitation facility. Of these, 32 percent lived alone, 38 percent had an annual income of less than $20,000, and 78 percent were unable to walk independently in the hospital before discharge.

Patients admitted to a rehabilitation facility were older (a mean of 74 years) than those discharged to home (72 years), and they had a shorter hospital stay (4.9 vs. 5.8 days). After adjusting for other factors, those who were unable to walk independently before discharge were much more likely to be discharged to a rehabilitation facility. Those who were older, living alone, or obese were 36 percent, 23 percent, and 29 percent more likely to be discharged to a rehabilitation facility, respectively.

More details are in "Determinants of discharge destination following elective total hip replacement," by Paola de Pablo, M.D., Elena Losina, Ph.D., Charlotte B. Phillips, R.N., M.P.H., and others, in the December 15, 2004, Arthritis & Rheumatism 51(6), pp. 1009-1017.

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