Nonhome Discharge After Total Joint Arthroplasty Increases Risk of Adverse Events

Patient discharge destination following total joint arthroplasty (TJA) is determined by several factors, including preoperative education, comorbidities, social support, intraoperative events, and hospital course [1,2]. Optimization of these factors allows home discharge in a majority of cases, critical to rapid recovery initiatives demonstrating decreased adverse events with outpatient TJA [3]. The current value-based care environment also makes home discharge more favorable from the perspective of cost [4].

When the TJA patient or care process is not optimized, then discharge to a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) is more likely. There is ample evidence that nonhome discharge after primary or revision TJA increases the risk of adverse events and hospital readmission, even after controlling for patient comorbidities [[5], [6], [7], [8], [9]]. Specifically, the likelihood of adverse events after primary TJA is 1.3 to 2.3-fold higher with discharge to SNF or IRF compared to home [5,8]. Readmission after primary TJA is 1.4 to 1.9 times more likely with nonhome discharge [5,7,8]. Similarly, the likelihood of adverse events after revision TJA is 1.6-fold higher with discharge to SNF or IRF compared to home [6]. Readmission after revision TJA is 1.3 to 1.5 times more likely with nonhome discharge [6].

To improve the likelihood of favorable TJA outcomes, patients should be counseled preoperatively on the deleterious consequences of SNF or IRF discharge. An important adjunct to this effort is establishing the availability of postoperative social support to facilitate home discharge [10]. However, it is possible that postoperative changes in a TJA patient’s medical condition or rehabilitation restrictions may necessitate SNF or IRF discharge. When a patient cannot be discharged home, it is important to be aware of the increased risk of adverse events.

Conflicts of Interest

Hari P. Bezwada has medical publications for JOA Editorial Board and is a board member of the AAHKS Evidence Based Medicine Committee and the AAOS Knee Program Committee.

Sumon Nandi has Medical/Orthopaedic publications on the editorial/governing board at Journal of Arthroplasty, Arthroplasty Today, Journal of Bone and Joint Surgery, Arthroplasty and is a board member of the AAHKS, AAOS, and Maryland Orthopaedic Association.

For full disclosure statements refer to https://doi.org/10.1016/j.artd.2025.101790.