Association of Race/Ethnicity With Hospital Discharge Disposition After Elective Total Knee Arthroplasty | Geriatrics | JAMA Network Open | JAMA Network
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    Original Investigation
    October 30, 2019

    Association of Race/Ethnicity With Hospital Discharge Disposition After Elective Total Knee Arthroplasty

    Author Affiliations
    • 1Medicine Service, VA Medical Center, Birmingham, Alabama
    • 2School of Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham
    • 3Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham
    • 4Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia
    • 5Hospital for Special Surgery, New York, New York
    • 6Department of Healthcare Policy and Research, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
    JAMA Netw Open. 2019;2(10):e1914259. doi:10.1001/jamanetworkopen.2019.14259
    Key Points español 中文 (chinese)

    Question  Is there an association of patient race/ethnicity with discharge disposition or 90-day hospital readmission after elective primary total knee arthroplasty?

    Findings  In this statewide cohort study of 107 768 patients, African American patients were 2.5- to 5-fold more likely than white patients to be discharged to an inpatient rehabilitation facility or skilled nursing facility rather than home health care or home self-care. Among patients younger than 65 years, African American patients also had 1.3-fold higher odds of 90-day hospital readmission in people, but there was no difference in patients 65 years or older.

    Meaning  African American patients were associated with worse outcomes after primary total knee arthroplasty than white patients of the same age.


    Importance  Total knee arthroplasty (TKA) is one of the most common elective procedures performed in adults with end-stage arthritis. Racial disparities in TKA outcomes have been described in the literature.

    Objectives  To assess the association of race/ethnicity with discharge disposition and hospital readmission after elective primary TKA and to assess the association of nonhome discharge disposition with hospital readmission risk.

    Design, Setting, and Participants  This retrospective cohort study used data from the Pennsylvania Health Care Cost Containment Council Database, a large regional database that included demographic data from all discharges of patients who underwent elective primary TKA in 170 nongovernmental acute care hospitals in Pennsylvania from April 1, 2012, to September 30, 2015. Data analyses were conducted from September 29, 2017, to November 29, 2017.

    Exposures  Patient race/ethnicity and discharge disposition.

    Main Outcomes and Measures  Discharge disposition and 90-day hospital readmission.

    Results  Among 107 768 patients, 7287 (6.8%) were African American, 68 372 (63.4%) were women, 46 420 (43.1%) were younger than 65 years, and 60 636 (56.3%) were insured by Medicare. In multivariable logistic regression, among patients younger than 65 years, African American patients were more likely than white patients to be discharged to inpatient rehabilitation facility (IRF) (adjusted relative risk ratio [aRRR], 2.49 [95% CI, 1.42-4.36]; P = .001) or a skilled nursing facility (SNF) (aRRR, 3.91 [95% CI, 2.17-7.06]; P < .001) and had higher odds of 90-day hospital readmission (adjusted odds ratio [aOR], 1.30 [95% CI, 1.02-1.67]; P = .04). Compared with white patients 65 years or older, African American patients 65 years or older were more likely to be discharged to SNF (aRRR, 3.30 [95% CI, 1.81-6.02]; P < .001). In both age groups, discharge to an IRF (age <65 years: aOR, 3.62 [95% CI, 2.33-5.64]; P < .001; age ≥65 years: aOR, 2.85 [95% CI, 2.25-3.61]; P < .001) or SNF (age <65 years: aOR, 1.91 [95% CI, 1.37-2.65]; P < .001; age ≥65 years: aOR, 1.55 [95% CI, 1.27-1.89]; P < .001) was associated with higher odds of 90-day readmission.

    Conclusions and Relevance  This cohort study found that race/ethnicity was associated with higher odds of discharge to an IRF or SNF for postoperative care after primary TKA. Among patients younger than 65 years, African American patients were more likely than white patients to be readmitted to the hospital within 90 days. Discharge to an IRF or SNF for postoperative care and rehabilitation was also associated with a higher risk of readmission to an acute care hospital.