Home vs. Rehab

Patients that are discharged home after TJA report higher satisfaction, outcome scores, and have a lower risk for ER readmission [1].  Many argue this is a selected population, that better outcomes occur because these patients are healthy enough to go home.  However, studies show that many of the variables to determine home discharge are unrelated to medical comorbidities. 

There are a number of determinants for who goes home after surgery [2].  Studies suggest ethnicity, gender, age, living arrangements, insurance carrier, preop expectations and hospital length of stay all play a role [3] [4] [5] [6].  In combination, these studies suggest that a black female over > 70 years old of lower-to-mid socioeconomic status, living alone, undergoing a TKA (vs. THA) with a friend that went to rehab after her TKA has the highest chance of going to a rehab center.  Female gender appears to statistically be the most important predictor (2x incidence), although other studies suggest preop patient expectation plays the biggest influence [7].  Another study balanced patients for insurance and age and found that ethnicity no longer played a significant role. 

It is important for surgeons to recognize that many factors contributing to discharge are more social than medical.  If patients are happier going home, and many of the factors determining discharge destination are outside of medical treatment, its beneficial for surgeons and patients to understand the best way to make a home discharge possible[8].

It is important for patients to recognize that care after TJA is a medical decision not an entitlement. 


1.         Rossman, S.R., et al., Selective Early Hospital Discharge Does Not Increase Readmission but Unnecessary Return to the Emergency Department Is Excessive Across Groups After Primary Total Knee Arthroplasty. J Arthroplasty, 2016. 31(6): p. 1175-8.
2.         Munin, M.C., et al., Predicting discharge outcome after elective hip and knee arthroplasty. Am J Phys Med Rehabil, 1995. 74(4): p. 294-301.
3.         Sharareh, B., et al., Factors determining discharge destination for patients undergoing total joint arthroplasty. J Arthroplasty, 2014. 29(7): p. 1355-1358 e1.
4.         Bozic, K.J., et al., Predictors of discharge to an inpatient extended care facility after total hip or knee arthroplasty. J Arthroplasty, 2006. 21(6 Suppl 2): p. 151-6.
5.         Barsoum, W.K., et al., Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty, 2010. 25(6): p. 885-92.
6.         Lavernia, C.J., et al., Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients. J Arthroplasty, 2004. 19(8): p. 978-85.
7.         Inneh, I.A., et al., Disparities in Discharge Destination After Lower Extremity Joint Arthroplasty: Analysis of 7924 Patients in an Urban Setting. J Arthroplasty, 2016.
8.         Iorio, R., Strategies and tactics for successful implementation of bundled payments: bundled payment for care improvement at a large, urban, academic medical center. J Arthroplasty, 2015. 30(3): p. 349-50.