Race, Discharge Disposition, and Readmissions After Elective Hip Replacement: Analysis of a Large Regional Dataset

Abstract

Purpose: Total hip arthroplasty (THA) is one of the fastest growing procedures. There is increasing evidence that social determinants of health influence health care utilization and outcomes after THA, including postoperative care. We sought to examine how race impacts discharge destination after elective THA, and we assessed the impact of discharge destination on 90-day readmission to an acute care hospital. Methods: We conducted a retrospective study using data from the Pennsylvania Health Care Cost Containment Council Database. We included patients of African American (AA) or white race undergoing THA, discharge disposition (inpatient rehabilitation facility [IRF], skilled nursing facility [SNF], home health care (HHC), home), and 90-day readmission rates. Results: Our study included 93,493 primary elective THAs. Compared with whites, AAs were more likely to be discharged to an IRF or SNF or HHC than home after THA. In all age groups, discharge to an IRF, SNF, or HHC for postop care/rehab was associated with higher odds of 90-day readmission as compared with home. Conclusion: AA race was associated with higher odds of discharge to an institution (IRF/SNF) or HHC for post-THA care. Disposition to these were associated with significantly higher risk of 90-day readmission to acute care hospital compared with home.

Keywords

• race
• rehabilitation
• THA
• readmissions