Predictive Factors of Inpatient Rehabilitation Stay After Elective Hip and Knee Replacement: A Scoping Review

Patient stratification strategies based on digital databases and advanced information technology can predict inpatient rehabilitation outcomes and support safe hospital discharge for patients who underwent joint replacement for hip and knee osteoarthritis. The degree of continuity between surgery and rehabilitation, the perioperative process integration, and the setting where rehabilitation is provided are crucial factors to improve care effectiveness, access, minimize readmissions, and cost increase. The primary aim of this scoping review of the literature is to identify perioperative variables that are predictive of inpatient rehabilitation stay after hip and knee arthroplasty for osteoarthritis. These factors are divided by time of assessment through the perioperative pathway and surgical procedure site. The secondary aim is to explore how different data sources and facilities are linked into a patient-centered perioperative pathway. An electronic search of the literature was performed on PubMed, Embase, and Scopus. No time restrictions were applied. All primary research studies investigating predictive factors of inpatient rehabilitation stay after hip and knee osteoarthritis were included. In total, 25 studies were included in the review. Age, caregiver presence, presence of comorbidities, sex, Body Mass Index, Risk Assessment and Prediction Tool composite score, pre-operative Clinician-Reported Outcome Measures, pre-operative Patient-Reported Outcome Measures, and post-operative Barthel Index of autonomy in the Activities of Daily Living were predictive of some degree of inpatient rehabilitation stay in more than one study. The studies were fairly distributed between retrospective and prospective, with multicentric databases more spread among the latter. Data collection occurred in acute hospitals more than in specialized rehabilitation facilities. Using comprehensive models supported by electronic health records and powerful information technologies, analyzing specific inpatient rehabilitation LOS as distinguished from surgical ward rehabilitation, using institutional registries, and including specific rehabilitation factors in these registries, and promoting vocabulary and federated data sharing can strongly enhance the predictivity of models investigating rehabilitation outcomes and support appropriate discharge from inpatient rehabilitation units.