Session Information
Date: Monday, November 9, 2015
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
Rural-urban disparities in outcomes after total joint arthroplasty are of great interest, given the differences in health care access and social support between those two settings. Our objective was to compare the discharge disposition after Total Knee Arthroplasty (TKA) in a nationally representative sample of patients.
Methods:
We used the U.S. Nationwide Inpatient Sample from 2003-2010 to compare outcomes after total knee arthroplasty (TKA). The study period was divided into two, 2003-2006 and 2007-2010 to assess changes in outcomes over time. Rural versus urban residence was determined based on patient’s residence at the time of surgery. We compared post-TKA outcomes including discharge disposition and the length of hospitalization by rural vs. urban patient residence. Patient discharge was categorized as home (with or without home health care) or to an inpatient facility (short term hospital, skilled nursing facility, intermediate care facility or another type of inpatient facility). Unadjusted and adjusted logistic regression and analyses of variance (ANOVA) were used to make rural-urban comparisons. We adjusted for age, race, gender, Charlson score and hospital TKA volume.
Results:
Overall, 61.3% of patients undergoing TKA in 2003-2010 were discharged to home and the mean length of stay was 3.6 days. During the 2003-2006 period, significantly higher proportion of patients residing in rural locations were discharged to home compared to urban location, 61.6% vs. 54.3%. Differences were still significant in 2007-2010 period, 69.6% vs. 65.1%, but the rural-urban disparity decreased significantly from 2003-2006 to 2007-2010 (p<0.0001; Table 1). There were no significant differences in hospital length of stay between rural and urban residents in 2003-2006 or 2007-2010 and no significant changes were noted over time (Table 1).
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Table 1. Rural-urban differences in TKA outcomes and time-trends |
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All combined |
Rural |
Urban |
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2003-2010 |
2003-2006 |
2007-2010 |
2003-2006 |
2007-2010 |
Unadjusted p-value |
Adjusted p-value* |
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Discharged home, n (%) |
532,618 (61.3%) |
50,527 (61.6%) |
76,480 (69.6%) |
157,201 (54.2%) |
241,452 (65.1%) |
<0.0001 <0.0001 <0.0001 |
<0.0001 <0.0001 <0.0001 |
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Length of stay, mean (SD or range) |
3.6 (1.9) |
3.9 (0, 70) |
3.4 (0, 108) |
3.8 (0, 172) |
3.4 (0, 215) |
0.78 0.61 0.59 |
0.16 0.17 0.69 |
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*Adjusted for age, race, gender, Charlson score, hospital TKA volume For p-values: first p-value denotes rural/urban disparity in 2003 -2006; second the rural/urban disparity in 2007 -2010 and the third denotes the change in the disparity magnitude between 2003 – 2006 and 2007 – 2010. |
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Conclusion:
In this study, we noted rural-urban disparity in post-TKA discharge to home. This disparity decreased over time. Future studies should investigate the factors responsible for this favorable time-trend in discharge disposition, and continue to investigate whether further improvements can be made in the proportion discharged to home.
To cite this abstract in AMA style:
Singh JA, Ramachandaran R. Reduction in Rural-Urban Disparity in Discharge Disposition to Home after Total Knee Arthroplasty in the U.S [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/reduction-in-rural-urban-disparity-in-discharge-disposition-to-home-after-total-knee-arthroplasty-in-the-u-s/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/reduction-in-rural-urban-disparity-in-discharge-disposition-to-home-after-total-knee-arthroplasty-in-the-u-s/