Destino de la descarga siguiente al reemplazo total electivo de cadera. (Inglés)

Paola de Pablo 1 *, Elena Losina 2, Charlotte B. Phillips 1, Anne H. Fossel 1, Nizar Mahomed 3, Elizabeth A. Lingard 4, Jeffrey N. Katz 1 1Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 2Brigham and Women's Hospital, Harvard Medical School, Boston University School of Public Health, and Boston University Medical School, Boston, Massachusetts 3Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada 4University of Newcastle upon Tyne, Newcastle and University of Bristol, Bristol, United Kingdom

Abstract

Objective
To identify the factors associated with discharge to an inpatient rehabilitation facility versus discharge directly to home after elective total hip replacement (THR).

Methods
Data were obtained from a medical record review and a cross-sectional survey of a population-based cohort of patients who received elective primary or revision THR in 1995. Postoperative functional status was measured as the ability to walk independently prior to discharge. A multivariate regression model was developed with discharge to an inpatient rehabilitation facility versus directly to home as the dependent variable. The model adjusted for demographic characteristics, socioeconomic features, and several preoperative and postoperative clinical factors.

Results
We included 1,276 patients age 65-94 years in the analysis. Of these, 58% were discharged from the acute care hospital to a rehabilitation facility. The cohort had mean age of 73 years; 96% were white; 62% were female; 32% were living alone; 38% had an annual income less than $20,000; and 78% were unable to walk independently in the hospital before discharge. For primary THR patients, multivariate analysis showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge, older age, obesity, and living alone. For revision THR patients, multivariate analysis also showed a significant association between being discharged to a rehabilitation facility and being unable to walk at discharge.

Conclusion
In a large population-based sample, postoperative functional status, age, obesity, and social support all influenced the discharge destination following elective THR.