The joint replacement team—Drs. Pelt, Gililland, Peters, PA Jill Erickson, and clinic manager Piper Ferrell—explain why going home after a joint replacement is better than going to a post-acute care facility. Their data shows that going home means better value for the patient: a healthier recovery at a lower cost. This presentation, "Patient Education Reduces Both Discharge to Post-Acute Care Facilities and Postoperative Complications," outlines the process.

1. Patient Education Reduces Both Discharge to
Post-Acute Care Facilities and Postoperative Complications
Christopher E. Pelt MD, Jeremy M. Gililland MD, Mike B. Anderson MSc,
Dory Trimble BA, Christopher Peters MD
University of Utah
Department of Orthopaedics
Salt Lake City, Utah 84108

2. Disclosures
• No funding was received for this study
• Two of the authors certify that they (CLP, CEP), or a
member of their immediate family has or may receive
payments or benefits (consulting, royalties, speakers
bureau), during the study period, from Zimmer Biomet,
Inc.
• One author (MBA) is a consultant for Orthogrid, Inc.
• One author (JMG) has equity interest in Orthogrid, Inc.
• One Author (CLP) is a board member and has equity
interest in CoNextions Medical.

3. Introduction
• Post-acute care centers (PACs) as rehabilitation
resources following primary TJA had been perceived to
improve outcomes.
• They are now believed to be an expensive cost center in
the 90-day episode of care, with the potential to increase
complications.

4. Hypotheses
1. Implementation of a preoperative patient
education program would result in fewer
patients discharged to PACs
2. The program would also result in fewer
30-day readmissions and 90-day
reoperations
3. Discharge to PACs is an independent risk
factor for 30-day readmissions and 90-
day reoperations

5. Methods
• IRB Exempt Retrospective Cohort Study
– Single tertiary referral center
– Primary THA or TKA
• CPT 27130 or 27447 (DRG 470)
– Program Implementation = March 2015
• Providers counseling patients that discharge to home
was preferred, Joint Academy, Patient Education
Videos, Preoperative Case Management
• 12 months before and after
– Outcomes
• Discharge to PACS
• 30 day readmissions
• 90 day reoperations

6. Statistics
 Multivariable modified Poisson regression
 Determine the relative risk for the outcomes of
interest
 Controlling for age, sex, BMI, ASA score,
Medicare as the primary payor, diabetes and
smoking
 Stepwise fashion

7. Demographics
Pre,
n=465
Post,
n=462
P-Value
Age, mean (range) 62 (61 – 63) 63 (62 – 64) 0.71
Sex, n (%)
Female (ref)
Male
262 (56%)
203 (44%)
265 (57%)
197 (43%)
0.755
BMI, mean (range) 30.4 (29.8 – 31.0) 30.5 (29.9 – 31.0) 0.797
ASA Score, median (IQR) 2 (2 – 3) 2 (2 – 3) 0.075

8. Results
• 59% relative reduction in discharge to PACs
(p<0.001)
− Pre-implementation: 34% (156/465)
− Post-implementation: 14% (64/462)
− IRR 2.56, 95% CI 2.00 – 3.28, p<0.001
• 30-day readmissions greater in patients that
underwent TJA prior to implementation
− IRR 1.93, 95% CI 1.01 – 3.69., p=0.047
• 90-day reoperations greater in patients that
underwent TJA prior to implementation
− IRR 1.67, 95% CI1.12 – 2.53, p=0.014

9. Results
• Overall, discharge to
PACs was an
independent risk factor
for:
• 30-day readmissions
− IRR 2.4
− 95% CI 1.28 – 4.56
− p=.0007
• 90-day reoperations
− IRR 1.75
− 95% CI 1.12 – 2.73
− p=0.013
Risk factors for thirty-day readmissions
Variable IRR 95% CI P-Value
Discharge to PACs 2.41 1.28 - 4.56 0.007
Age 0.99 0.96 – 1.02 0.490
Male sex 2.34 1.21 – 4.50 0.011
Risk factors for ninety-day reoperations
Variable IRR 95% CI P-Value
Discharge to PACs 1.75 1.12 – 2.73 0.013
Age 0.97 0.96 – 0.99 0.007
Male sex 1.05 0.70 – 1.59 0.785
BMI 1.02 0.99 – 1.05 0.060
ASA score 1.14 0.82 – 1.60 0.436
Medicare 0.70 0.41 – 1.20 0.199

10. Conclusion
• Patient Education focused on benefits of returning
to home after TJA resulted in
– patients discharged to PACs
– 30 day readmissions
– 90 day reoperations
• Limited to data from our institution
– Does not include the potential for difference in
reoperations and readmissions elsewhere
• Discharge to PACs was an independent risk factor
for increased readmissions and reoperations
– After controlling for potential confounders