A study of 107,000 knee replacement surgeries has found that African American patients are 2.5-to-5 times more likely than white patients to be discharged to a skilled nursing facility or an inpatient rehabilitation facility rather than to their home.
The data analysis also found that almost 50% of African American patients were discharged to a skilled nursing facility in 2015. However, while African American patients younger than age 65 also had 1.3-times higher odds of 90-day hospital readmission than their white peers, there was no difference in hospital readmission rates in patients who were 65 or older.
“It is possible that the decision on where to discharge patients after a surgical procedure is informed not only by clinical indications but also by social determinants of health, including socioeconomic status, employment, and social support, of which race/ethnicity might be a marker,” the authors theorized.
“We need to understand that there are people who may not fit into the new complex reimbursement bundles who require specialized care,” said orthopedic surgeon Michael Parks, M.D., of the Hospital for Special Surgery, New York City. “And we need to make sure we address their needs going forward.”
Demand for total knee replacement in the United States has been projected to increase by more than 600% between 2005 and 2030. Postoperative care and rehabilitation after surgery account for a significant portion of the overall cost of care, reported the study’s authors.
The study was published in JAMA Network Open.