The Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review

Onggo, James Randolph; Onggo, Jason Derry; Steiger, Richard de; Hau, Raphael

doi:10.1016/j.arth.2019.04.001

Cited by 33 publications

(23 citation statements)

References 39 publications

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“…Another point of interest is that a recent meta‐analysis of predominantly retrospectively collected administrative data concluded that discharge to IR is associated with almost five and three times the odds for readmission and periprosthetic complications, respectively, compared with discharge home ( 13 ). Our study points to a possible cause of a greater rate of adverse events amongst people referred to IR after TKA—greater opioid use.…”

Section: Discussionmentioning

confidence: 99%

Prescription Opioids Higher Among Knee Arthroplasty Recipients Randomized to Inpatient Rehabilitation

Naylor

Buhagiar²,

Johns

et al. 2021

ACR Open Rheumatology

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Objective To determine whether the purchase of prescription opioids was lower among people randomized to inpatient rehabilitation (IR) compared with those discharged directly home following total knee arthroplasty (TKA). Method A secondary analysis of a previous clinical trial in which participants were randomized 3 to 5 days after ‐surgery to 10 days of IR and a home program or to a home program alone. The primary outcome for this secondary analysis was the purchase of opioid‐based pain relief up to 10‐weeks after surgery, which was captured via patient diaries. Between‐group differences were analyzed using a χ2 test and relative risk (RR) (95% confidence interval [CI]). We report this outcome alongside the main outcomes observed at 10 weeks for the original study (6‐minute walk test, index joint pain, and function) for context. Results At 10 weeks, 158 participants were available for follow‐up; 120 (76%) provided diaries, with 113 providing generic or brand names for the pain relief purchased. In the IR group, 60% (33/55) reported the purchase of opioid‐based medications after discharge compared with 34% (20/58) in the home group (χ2 = 7.4; P = 0.007); thus, the risk of purchasing opioids for those in the IR group was almost double (RR, 1.7 [95% CI, 1.1‐2.6]). No significant or meaningful between‐group differences in index joint pain, function, or mobility were observed. Conclusion Contrary to what was hypothesized, IR is a strong driver of opioid purchase after discharge from the hospital following TKA.

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Section: Discussionmentioning

confidence: 99%

Prescription Opioids Higher Among Knee Arthroplasty Recipients Randomized to Inpatient Rehabilitation

Naylor

Buhagiar²,

Johns

et al. 2021

ACR Open Rheumatology

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“…Interestingly, it is noted that the significantly higher rate of discharge to IRF in obese patients could also be a driver of complications post THA. A recent meta-analysis by Onggo 78 found that patients discharged to IRF have 4.87 and 2.82 times the risk of readmissions and peri-prosthetic complications (including dislocations) post joint replacement surgeries. Hence, discharge destination may be a significant confounder of this result.…”

Section: Discussionmentioning

confidence: 99%

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Onggo

Steiger

et al. 2020

Osteoarthritis and Cartilage

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Background: Obesity is an epidemic, especially in developed countries. This affects the general health of these patients, especially when they are having a major surgical procedure such as total hip arthroplasty (THA). Several articles have described the effects of obesity on THA with varying conclusions. This metaanalysis aims to compare the outcomes, complications, and peri-operative parameters of THA in the obese (BMI!30 kg/m 2) vs non-obese (BMI<30 kg/m 2) population as well as a subgroup analysis of morbidly obese (BMI!40 kg/m 2) vs non-obese population. Methods: A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the outcomes and complications of THA in the obese and non-obese population were extracted and analyzed. Results: Sixty-seven studies were included in this meta-analysis, consisting of 581,012 obese and 1,609,812 non-obese patients. Meta-analysis could not be performed on patient reported outcome measures due to heterogeneous reporting methods. Obese patients had a higher risk of all complications (OR ¼ 1.53, 95%CI: 1.30e1.80, P < 0.001), deep infections (OR ¼ 2.71, 95%CI: 2.08e3.53, P < 0.001), superficial infections (OR ¼ 1.99, 95%CI: 1.55e2.55, P < 0.001), dislocations (OR ¼ 1.72, 95%CI: 1.66e1.79, P < 0.001), reoperations (OR ¼ 1.61, 95%CI: 1.40e1.85, P < 0.001), revisions (OR ¼ 1.44, 95%CI: 1.32e1.57, P < 0.001), and readmissions (OR ¼ 1.37, 95%CI: 1.15e1.63, P < 0.001). When subgroup analysis of morbidly obese (BMI!40 kg/m 2) patients was performed, the risks of all these parameters were even greater. Conclusion: Obese and morbidly obese patients are at higher risks of complications post THA than nonobese patients. Surgeons should be aware of these risks in order to counsel patients and adopt prophylactic strategies to reduce these risks where applicable.

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“…Use of inpatient rehabilitation following elective total knee and total hip replacements is more common among patients with private health insurance in Australia (56% and 33% vs 8% and 4% uninsured respectively). 1 However, for uncomplicated cases, inpatient rehabilitation is not associated with improved patient outcomes compared with home-based rehabilitation [2][3][4] and is more costly. 5 Cabrini Health, a large Victorian not-for-profit private healthcare service, conducts a high volume of elective orthopaedic surgery and offers home-based and inpatient rehabilitation.…”

mentioning

confidence: 99%

Utilisation of inpatient rehabilitation following elective total knee or hip replacements in private hospital setting declined during the COVID‐19 pandemic

Wallis

Young

Zayontz

et al. 2021

Internal Medicine Journal

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The Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review

Cited by 33 publications

References 39 publications

Prescription Opioids Higher Among Knee Arthroplasty Recipients Randomized to Inpatient Rehabilitation

Prescription Opioids Higher Among Knee Arthroplasty Recipients Randomized to Inpatient Rehabilitation

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Utilisation of inpatient rehabilitation following elective total knee or hip replacements in private hospital setting declined during the COVID‐19 pandemic

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