Health Policy and EconomicsHospital Readmissions After Total Joint Arthroplasty: An Updated Analysis and Implications for Value-Based Care
Section snippets
Material and Methods
This study was exempt from an institutional review board approval. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried using the Current Procedural Terminology (CPT) codes 27447 and 27130 to identify all patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between January 1, 2011 and December 31, 2018. This period was selected (1) to eliminate the potential confounding effects of COVID-19 (and
Results
Of the 367,199 primary TKAs and THAs performed between 2011 and 2018, there were 15,594 readmissions (4.2%) within 30 days of the index procedure. Annual readmission rates showed a downward trend over the study period for both TKA and THA, decreasing from a high of 4.6% and 4.1% in 2011 to a low of 3.0% and 3.2% in 2018 for TKA and THA, respectively. (Figure 1).
Of the patients who were readmitted following TKA, 4,574 (52.6%) were due to medical complications and 3,275 (37.7%) were due to
Discussion
We found that 4.2% of primary TJA patients within the NSQIP database were readmitted to the hospital within 30 days. This readmission rate was similar to the rate of 4.0% reported by Kurtz et al [25] using a national database but compared favorably to the rate of 5.8% reported by D’Apuzzo et al [26] in an analysis of a New York state registry. We also observed a downward trend in 30-day readmissions over the study period from 4.5% in 2011 to a low of 3.3% in 2018. This represents a reversal of
Conclusion
The rate of 30-day readmission after primary TJA has been trending downward, reaching a low of 3.2% and 3.0% in 2018 for THA and TKA, respectively. Medical complications accounted for half of all TKA readmissions and more than a third of THA readmissions. Surgeon-directed patient optimization and medical comanagement may help to reduce these costly readmissions. Medical readmissions could penalize institutions participating in value-based payment programs or dissuade others who are considering
References (42)
- et al.
Cost analysis of total joint arthroplasty readmissions in a bundled payment care improvement initiative
J Arthroplasty
(2016) - et al.
Cost burden of 30-day readmissions following medicare total hip and knee arthroplasty
J Arthroplasty
(2014) - et al.
The “bundle busters”: incidence and costs of postacute complications following total joint arthroplasty
J Arthroplasty
(2018) - et al.
Comparison of outpatient vs inpatient total knee arthroplasty: an ACS-NSQIP analysis
J Arthroplasty
(2017) - et al.
Complications following outpatient total joint arthroplasty: an analysis of a national database
J Arthroplasty
(2017) - et al.
Early discharge after total hip and knee arthroplasty—an observational cohort study evaluating safety in 330,000 patients
J Arthroplasty
(2020) - et al.
Is outpatient total hip arthroplasty safe?
J Arthroplasty
(2017) - et al.
Reasons and risk factors for 30-day readmission after outpatient total knee arthroplasty: a review of 3015 cases
J Arthroplasty
(2020) - et al.
Ten-year trends and independent risk factors for unplanned readmission following elective total joint arthroplasty at a large urban academic hospital
J Arthroplasty
(2017) - et al.
The association of ASA class on total knee and total hip arthroplasty readmission rates in an academic hospital
J Arthroplasty
(2015)
The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty
J Arthroplasty
The effect of preoperative anemia on complications after total hip arthroplasty
J Arthroplasty
The effect of smoking on thirty-day postoperative complications after total joint arthroplasty: a propensity score-matched analysis
J Arthroplasty
Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP
J Arthroplasty
Incidence, risk factors, and costs for hospital returns after total joint arthroplasties
J Arthroplasty
Reasons for ninety-day emergency visits and readmissions after elective total joint arthroplasty: results from a US integrated healthcare system
J Arthroplasty
Predictive risk factors for 30-day readmissions following primary total joint arthroplasty and modification of patient management
J Arthroplasty
Risk of gastrointestinal bleeding with extended use of nonsteroidal anti-inflammatory drug analgesia after joint arthroplasty
J Arthroplasty
The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty
J Arthroplasty
Evaluation of a preoperative optimization protocol for primary hip and knee arthroplasty patients
J Arthroplasty
Failure to optimize before total knee arthroplasty: which modifiable risk factor is the most dangerous?
J Arthroplasty
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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2022.09.015.