EFFECTS OF REHABILITATION ON HEALTH OUTCOMES AND MEDICAL COSTS AFTER TOTAL KNEE REPLACEMENT

Purpose: The purpose of this study is to understand the impact of rehabilitation on health outcomes and medical utilization of total knee replacement (TKR) patients.

Method: The Taiwan National Health Insurance (NHI) database of 2004-2006 were used in this retrospective secondary analysis. Study samples were those who received TKR procedure during 2004-2005, and their rehabilitation time, medical costs, deep venous thrombosis (DVT) occurrence rate and chances of infection within a year after operation were also examined. SAS 9.0 was used for descriptive analyses, and chi-square, one-way ANOVA, linear regression and logistic regression were used to investigate medical cost within the year after operation.

Result: A total of 18,323 subjects were included in the study, 15,898 females (75.19%) and 2,425 males (24.81%), averaging 69.68 years old with total medical cost of New Taiwan Dollar (NTD) 67,564.68, 10.96 following outpatient revisits, 10.62 chronic diseases, Charlson comorbidity score of 1.85, and 39.31 outpatient visits.  Chi-square showed that patients who received rehabilitation had lower occurrence rates of deep venous thrombosis (p=0.0444), and those who received rehabilitation immediately after operation had lower rates of infection (P<0.0001).  Linear regression showed that patients who received immediate rehabilitation had lower hospitalization costs than patients who did not receive rehabilitation, and patients who received delayed rehabilitation had higher hospitalization costs than those who did not receive rehabilitation.  Logistic regression showed that patients who receive immediate rehabilitation showed lower occurrence rates of hospitalization due to infection (OR=0.627, p<.0001) and DVT (OR=0.766, p=.033) when compared to patients who did not receive rehabilitation.

Conclusion: Since hospitalization costs are usually incurred under inevitable circumstances (unlike visitation costs that are often influenced by personal factors), this study found that hospitalization costs were lower for patients who received rehabilitation than those who do not, and receiving it immediately after operation can improve chances of recovery. After TKR, hospital management units should offer health education to the patients, and promote the importance of immediate rehabilitation to reduce chances of DVT and infections, as well as improving life quality for individuals. Early rehabilitation can also diminish medical resource consumption and increase efficiency.