Association of Race/Ethnicity with Hospital Discharge Disposition after Elective Total Knee Arthroplasty

Abstract

Importance: Total knee arthroplasty (TKA) is one of the most common elective procedures performed in adults with end-stage arthritis. Racial disparities in TKA outcomes have been described in the literature. Objectives: To assess the association of race/ethnicity with discharge disposition and hospital readmission after elective primary TKA and to assess the association of nonhome discharge disposition with hospital readmission risk. Design, Setting, and Participants: This retrospective cohort study used data from the Pennsylvania Health Care Cost Containment Council Database, a large regional database that included demographic data from all discharges of patients who underwent elective primary TKA in 170 nongovernmental acute care hospitals in Pennsylvania from April 1, 2012, to September 30, 2015. Data analyses were conducted from September 29, 2017, to November 29, 2017. Exposures: Patient race/ethnicity and discharge disposition. Main Outcomes and Measures: Discharge disposition and 90-day hospital readmission. Results: Among 107768 patients, 7287 (6.8%) were African American, 68372 (63.4%) were women, 46420 (43.1%) were younger than 65 years, and 60636 (56.3%) were insured by Medicare. In multivariable logistic regression, among patients younger than 65 years, African American patients were more likely than white patients to be discharged to inpatient rehabilitation facility (IRF) (adjusted relative risk ratio [aRRR], 2.49 [95% CI, 1.42-4.36]; P =.001) or a skilled nursing facility (SNF) (aRRR, 3.91 [95% CI, 2.17-7.06]; P <65 years: aOR, 3.62 [95% CI, 2.33-5.64]; P <65 years: aOR, 1.91 [95% CI, 1.37-2.65]; P