DISCHARGE FACILITIES / DISPOSITION

There were no high quality and three low quality studies (Naylor 2017, McLawhorn 2017, Padgett 2018) evaluating whether discharge to an acute rehabilitation facility or skilled nursing facility improve outcomes and/ or decrease complications compared with discharge to home, with or without home services.

McLawhorn (2017) showed fewer adverse events and readmissions with home discharge. Padgett (2018) demonstrated a higher length of stay with home discharge, but no difference in adverse events. Naylor (2017) showed significantly better functional scores with home discharge. In the absence of reliable, comparative studies a consensus recommendation was made by the workgroup.

It is worth noting that literature comparing costs associated with discharge disposition was not included for analysis.

Benefits/ Harms of Implementation

There are no known harms associated with implementing this recommendation. The decision to discharge a patient to home versus post-acute care facility should be made with consideration of patient’s medical complexity and postoperative function. The practitioner should be aware of the advantages and disadvantages of specific discharge disposition.

Future Research

Higher-quality studies are needed to compare outcomes associated with discharge disposition following total knee arthroplasty. Of note, Christensen (2020) showed significantly better VAS Pain, strength, and functional testing at onemonth post-op with immediate outpatient physical therapy as compared to immediate home physical therapy followed by outpatient therapy. While this was not included in the recommendation, this may be another opportunity for further research.