Original article
Sex and Age Effects on Outcomes of Total Hip Arthroplasty After Inpatient Rehabilitation

https://doi.org/10.1016/j.apmr.2006.01.002Get rights and content

Abstract

Vincent HK, Alfano AP, Lee L, Vincent KR. Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation.

Objective

To retrospectively examine the effects of sex and age on the inpatient rehabilitation outcomes of patients after total hip arthroplasty (THA).

Design

Exploratory, retrospective study.

Setting

A university-affiliated rehabilitation hospital.

Participants

Male and female THA patients (N=332) were stratified into age brackets (<65y, 65–84y, ≥85y). All patients completed interdisciplinary inpatient rehabilitation.

Interventions

Not applicable.

Main Outcome Measures

Length of stay (LOS), FIM instrument scores, FIM efficiency (FIM/LOS), hospital costs, and discharge disposition location were collected by chart review.

Results

Regardless of age, women had lower FIM scores at admission and discharge than men (P<.05). FIM efficiency was 22% to 53% lower for women in primary THA and 16% to 85% lower in revision THA than men (P=.001). Women accrued higher total hospital charges than men ($13,099 vs $11,141; P<.05), and were discharged home less frequently than men (84.4% vs 90.9%; P<.05). Admission FIM scores were 10.6% and 8.9% lower and discharge FIM scores were 7.3% and 9.2% lower in patients 85 years or older than those less than 65 or 65 to 84 years (P<.01). FIM efficiency was 25% to 38% higher in patients less than 85 years than those 85 years and older (P=.015), and 37% higher in men than women (P=.001). Patients 85 years and older were discharged less frequently to home than patients less than 85 years (P<.05).

Conclusions

All patients made functional improvement after inpatient rehabilitation, but women and patients 85 years and older had longer LOS and lower FIM efficiency, incurred greater hospital charges, and were less likely to be discharged to home than men and younger counterparts.

Section snippets

Study Design

The design was an exploratory, retrospective study utilizing data from the computerized medical records system of the university-affiliated rehabilitation hospital. We collected and analyzed the data for this investigation in accordance with the procedures and policies set forth by the Human Investigation Committee at the University of Virginia (UVA).

Participants

The population sample was a convenience sample. Data from the UVA Clinical Data Repository indicated that the total UVA THA population during the

Participant Characteristics

Table 1 contains the subject characteristics for men and women. More men were heavier, were smokers, and had ischemic heart disease than women (P<.05). More men (77.75%) were insured by Medicare, whereas 17.6% were insured by private carriers. Most of the women (84.1%) were insured by Medicare and 8.5% were insured by private carriers (not shown). All other descriptors and revision etiologies were not statistically different between men and women. The comorbidities are shown in table 2. A

Discussion

To our knowledge, this retrospective exploratory analysis is the first to analyze the influence of age and sex on several outcome measures of inpatient rehabilitation after THA. There were 2 major findings of this study. First, women had lower functional capacity than men at admission and discharge regardless of age. This finding was concurrent with a longer LOS and a lower FIM efficiency in women than men during rehabilitation. Second, elderly patients (≥85y) had lower functional capacity and

Conclusions

Regardless of age or sex, all THA patients can gain substantial physical function during postoperative inpatient rehabilitation. The outcomes following inpatient rehabilitation, however, differ for men and women and those of various age brackets. These findings have implications for goal setting and rehabilitation hospital discharge planning, and may affect case management under the prospective payment system. The rehabilitation team should be aware that older women are more likely to require

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    Supported in part by the National Center for Complementary and Alternative Medicine (NCCAM) (grant no. T32-AT00052). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCCAM or the National Institutes of Health.

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