Discharge to Post-Acute Care Facility After Total Knee Arthroplasty Is Associated With Worse Mental Health Outcomes.

Abstract

Discharging total knee arthroplasty (TKA) patients to post-acute care facilities remains a common practice, particularly in elderly patients who have major comorbidities. Efforts have been made to limit discharge to these facilities to avoid increased health care costs and potentially improve outcomes. The aim of this study was to compare patient-reported outcomes (PROs) of TKA patients discharging to a facility versus home. We conducted a retrospective study using the Pulmonary Embolism Prevention after Hip and Knee Replacement database of TKA patients who were discharged to a facility or home between 2016 and 2019. Propensity score matching was used to create comparable groups of patients. The PROs, including Knee Injury and Osteoarthritis Outcomes Score (KOOS Jr) and Patient-Reported Outcomes Measurement Information System (PROMIS) global physical health (GPH), and PROMIS global mental health (GMH) were collected pre- and post-operatively. Outcomes were assessed between the two groups using general linear models. After propensity matching, a total of 942 patients (471 home, 471 facility) were included in the study. The KOOS Jr. scores were not significantly different between the two groups at any time point, and both groups saw significant improvement in scores from baseline to the 1-month visit. Patients discharged to a post-acute care facility had significantly worse scores on both the PROMIS GPH and GMH scores at all time points despite an initial increase from preoperative baseline. Nonhome discharge patients had declining GMH scores at the 3-month and 6-month visits, whereas in the home discharge cohort, GMH scores continued to rise. Our data suggest discharge disposition may influence PROs in matched patients following TKA. Similar trajectories of improvement were seen in KOOS Jr. and GPH scores. The GMH scores started lower and declined after the 1-month time point in the nonhome group. Further study is required to determine if the discharge to a post-acute care facility is causal in the declining mental health scores seen in that cohort. Level III.