PLAN and AM-PAC “6-Clicks” Scores to Predict Discharge Disposition After Primary Total Hip and Knee Arthroplasty

• DOI: 10.2106/jbjs.21.00503
• Publication Date: 2021-12-20T19:39:32Z
• Authors: Matthew J. Hadad; Melissa N. Orr; Ahmed K. Emara; Alison K. Klika; Joshua K. Johnson; Nicolas S. Piuzzi
• Keywords: Concordance; Nomogram

Determination of the appropriate post-discharge disposition after total hip (THA) and knee (TKA) arthroplasty is a challenging multidisciplinary decision. Algorithms used to guide this decision have been administered both preoperatively postoperatively. The purpose study was simultaneously evaluate predictive ability 2 such tools-the Predicting Location Arthroplasty Nomogram (PLAN) postoperatively Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" basic mobility tools-in accurately determining discharge elective THA TKA.The included 11,672 patients who underwent (n = 4,923) or TKA 6,749) at single large hospital system from December 2016 through March 2020. PLAN scores were recorded all patients. Regression models receiver operator characteristic curves constructed tools' prediction concordance with actual (home compared facility).PLAN had index 0.723 cohort 0.738 cohort. first score (recorded within 48 hours postoperatively) 0.813 0.790 When together, 0.836 observed agreed on home discharge, higher rates (98.0% 97.7% TKA) lower readmission (5.1% 7.0% observed, when tools disagreed.PLAN good-to-excellent predictors primary joint arthroplasty, suggesting that preoperative postoperative variables influence disposition. We recommend be collected generate tentative plan final augmented by early evaluation.The determination needs remains complex clinical This shows how exploring assessment may useful aid in value-driven health-care model.