Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement.
Kevin T Pritchard, Ickpyo Hong, James S Goodwin and 3 others
PMID 33041232WHAT IT FOUND
After hip or knee replacement, patients with higher pain, obesity, smoking or substance use were less likely to go home.
Alcohol use was linked with greater likelihood of going home. These are associations from records, not proof that changing them alters discharge.
Key findings
01Patients with pain scores of 4-6 or 7-10 had lower odds of community discharge than patients without pain.
02Current smoking and substance use disorder were associated with lower odds of community discharge after hip or knee replacement.
03Obesity was associated with lower odds of community discharge after hip and knee replacement, while alcohol use was associated with higher odds after hip and knee replacement.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is an observational record analysis, so it cannot show that any factor caused community discharge or that changing it would change discharge. Not all electronic health record data were available across providers and systems, and some values had to be extracted from notes. Pain was summarized as an average score on the day nearest discharge, not always the last score before discharge. Non-white patient groups were smaller than US census averages, so results may not apply equally to all patients. The paper reports different total sample sizes: final cohorts of 79,725 hip and 136,070 knee patients, and later a sample size of 123,364 elective joint arthroplasties. Alcohol use was associated with higher odds of community discharge, which the authors say may be confounded by better health.
Declared interests
No conflict-of-interest statement is included in the supplied text. The publication types list NIH extramural and U.S. government PHS research support.
The easy way to misread this
Do not conclude that improving pain, weight, smoking, alcohol use or substance use will increase community discharge. This paper found associations in records, not effects of treatment. The alcohol finding may also reflect that some patients who misuse alcohol were healthier overall.