Low Resilience Is Predictive of Skilled Nursing Facility Discharge After Total Hip Arthroplasty.

Abstract

Total hip arthroplasty (THA) remains one of the most successful orthopaedic procedures to date, with about 90% of patients experiencing major improvements in pain and mobility. Despite its long-standing success, a subset of patients undergoing THA requires discharge to a skilled nursing facility (SNF). Preoperative resilience, assessed using the Brief Resilience Scale (BRS), may help to provide insights into which patients have poor outcomes. This was a retrospective cohort study of 1,982 patients undergoing elective primary unilateral THA at a single institution from May 2020 to June 2023. Patients were stratified into three groups, low, average, and high resilience based on preoperatively assessed BRS: < 3, ≥ 3 and < 4.3, and ≥ 4.3, respectively. Demographic, clinical, and surgical parameters were analyzed alongside postoperative outcomes, including pain levels, opioid use, functional recovery, and discharge disposition. Logistic regression models assessed predictors of SNF discharge, with sensitivity and specificity evaluated using receiver operator characteristic analysis. Patients who had low resilience (BRS < 3) were significantly more likely to require SNF discharge (16.2%) compared to those who had a BRS ≥ 4.3 (1.0%, P < 0.0001). These patients had longer hospital stays (P < 0.0001), shorter ambulation distances (P = 0.0051), and worse patient-reported outcomes overall. Univariate modeling using preoperative BRS and Risk Assessment and Prediction Tool scores, age, and postoperative physical therapy parameters was able to determine with 87.8% sensitivity and 96.9% specificity the probability of a SNF discharge. Low preoperative resilience is strongly associated with poor postoperative outcomes following THA, including increased pain, delayed functional recovery, and SNF discharge. Incorporating BRS into preoperative assessments can improve patient stratification, assist in surgical planning, and guide interventions to enhance patients' postoperative trajectories. These findings support the integration of resilience-building strategies into perioperative care to optimize outcomes in this growing patient population. III.