Health Policy and Economics
Hospital Readmissions After Total Joint Arthroplasty: An Updated Analysis and Implications for Value-Based Care

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Abstract

Background

While risk factors have been published for readmissions following primary total joint arthroplasty, little is known about the etiology of those costly adverse events. In this study, we sought to identify the reasons for 30-day readmission following primary total joint arthroplasty in a contemporary national patient sample.

Methods

The American College of Surgeons National Surgical Quality Improvement Program was queried to identify 367,199 patients who underwent primary total knee (TKA) or hip arthroplasty (THA) between 2011 and 2018. The primary outcomes were the annual rates of 30-day readmissions and the causes of those readmissions.

Results

The 30-day readmission rate trended downward from 4.5% in 2011 to 3.3% in 2018. Medical complications accounted for 52.6% and 38.5% of readmissions following TKA and THA, respectively. Diseases of the circulatory system, abnormal laboratory values, and diseases of the digestive system were the leading causes of medical readmissions. Surgical complications accounted for 37.7% and 50.7% of readmissions following TKA and THA, respectively. Surgical site infections/wound disruption and venous thromboembolism were the leading two causes of surgical readmissions for THA and TKA. Prosthetic complications—namely dislocations and periprosthetic fractures—were the third leading cause of surgical readmissions for THA. For TKA, musculoskeletal conditions—namely pain and hematoma—were the third leading cause of surgical readmissions.

Conclusion

Medical complications accounted for half of all TKA readmissions and more than a third of THA readmissions. This could penalize institutions participating in value-based payment programs or dissuade others who are considering participation in such programs.

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

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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.

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