Associations Between Prehabilitation and Postoperative Healthcare Utilization for Total Hip or Total Knee Arthroplasty in Medicare Beneficiaries.
J Arthroplasty
; 2024 Sep 14.
Article
en En
| MEDLINE
| ID: mdl-39284390
ABSTRACT
BACKGROUND:
Prehabilitation has potential to improve outcomes in value-based care models. We examined the associations between receipt of prehabilitation (physical therapy [PT] services within 30 days preoperatively) and postoperative healthcare utilization in a national cohort of fee-for-service Medicare beneficiaries.METHODS:
This retrospective cohort study used the 5% fee-for-service claims from the Medicare Limited Data Set to identify unilateral elective inpatient total hip arthroplasty (THA) procedures (n = 25,509) and total knee arthroplasty (TKA) procedures (n = 40,091) from January 1, 2016 to September 30, 2021. Associations between prehabilitation and postoperative healthcare utilization were analyzed in mixed-effects generalized linear models adjusting for patient-level and hospital-level factors. We report adjusted odds ratios (OR) or % differences.RESULTS:
Prehabilitation (13.1% THA, 13.1% TKA) was not significantly associated with institutional post-acute care discharge, 30-day emergency department visits, or 90-day readmissions. For TKA, prehabilitation was significantly associated with decreased odds of an extended hospital length of stay (OR = 0.86, P = 0.02) and reduced length of stay in an institutional post-acute care facility (-5.71%, P = 0.004). In both THA and TKA, prehabilitation was associated with decreased use of 90-day home health physical and/or occupational therapy (THA OR = 0.82, P = 0.001; TKA OR = 0.67, P < 0.001). In contrast, prehabilitation in both cohorts was associated with increased odds of receiving any 90-day outpatient PT (THA OR = 2.08, P < 0.001; TKA OR = 2.48, P < 0.001) and an increased number of 90-day outpatient PT visits (THA +4.04%, P = 0.01; TKA +5.21%, P < 0.001).CONCLUSION:
Prehabilitation was associated with some decreases in postoperative healthcare utilization, particularly for TKA. Associations of preoperative physical therapy with increased postoperative outpatient physical therapy may reflect variation in referral patterns or patient access. These results highlight the importance of continued research into the impact of prehabilitation on healthcare utilization, patient outcomes, and episode costs. Additionally, further research should identify which patients would benefit the most from prehabilitation to increase the value of care.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Idioma:
En
Revista:
J Arthroplasty
Asunto de la revista:
ORTOPEDIA
Año:
2024
Tipo del documento:
Article
Pais de publicación:
Estados Unidos