Smokers and Indigenous people are more likely to be discharged home after hip and knee arthroplasty

Background: Total hip (THA) and knee (TKA) discharge disposition is of increasing interest as leaner models are sought, emphasizing the importance of factors affecting discharge disposition. Utilizing the National Surgical and Quality Improvement Program (NSQIP), we hypothesized discharge to home would (1) be more frequent in men, (2) be adversely affected by comorbidities but not by race, and (3) increase in percentage each year. Methods: The NSQIP 2015–2018 database revealed 883,309 orthopedic surgical patients, 413,627 having undergone joint arthroplasty. The primary endpoint was discharge to home. Chi-square tests examined categorical dependent variables, and analysis of variance (ANOVA) assessed continuous variables, with statistical significance accepted for p < 0.001. Results: Male sex (AOR = 1.76, p < 0.001) and current smoker status (AOR = 1.18, p < 0.001) were associated with significant increase in odds of home discharge. From 2015 to 2018, odds of discharge home more than doubled (OR = 2.04, p < 0.001). Individuals who received TKA (AOR = 1.05, p < 0.001) or primary arthroplasty (AOR = 1.67, p > 0.001) were more likely to be discharged home compared to THA or revision arthroplasty. Race and Ethnicity varied likelihood of going home. Regardless of Ethnicity, Black/African American individuals were least likely to be discharged home. Of patients with reported Ethnicity, Indigenous Non-Hispanics and Indigenous Hispanics had the highest odds of discharge home (OR = 1.94; 1.77, p < 0.001; 0.004, respectively). Conclusion: Men, Indigenous patients, and smokers are more likely to be discharged home. This suggests social factors and context play a role in discharge destination. Percent discharged home increased over each year of the study, related to increased emphasis on cost containment.