Are Readmissions After THA Preventable?

Weinberg, Douglas S.; Kraay, Matthew J.; Fitzgerald, Steven J.; Sidagam, Vasu; Wera, Glenn D.

doi:10.1007/s11999-016-5156-x

Cited by 24 publications

(22 citation statements)

References 60 publications

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“…Thus, the results of this study not only demonstrate that C-PE and COC bearings are following a similar (and expected) decreasing trend in readmission rates over time, but that the trend in readmission rates extends 1 year beyond the final rule established in the HRRP. In theory, there should be a lower limit or plateau in hospital 33,34 Our current data would suggest that, at least up to 2015, a plateau in readmission rates has not yet been achieved, at least not for the Medicare population. Hospitals and accountable care organizations that are concerned with the effect of ceramic bearings on their hospital quality measures and potential financial claw backs from Medicare can be further assured that the usage of C-PE or COC bearings will not negatively impact their 30-or 90day readmission rates.…”

Section: Discussionmentioning

confidence: 76%

Ceramic-on-Polyethylene Bearing Usage in Primary THA Is Associated with Reduced Readmission Risk for the Medicare Population

et al. 2018

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The authors hypothesized that unplanned readmissions, which are often caused by infections and dislocation, may be reduced with ceramic bearing usage. They also sought to confirm that the readmission rates for ceramic bearings were associated with the year of surgery. They identified 245,077 elderly patients (65+) who underwent primary total hip arthroplasty (THA) between 2010 and 2015 with known bearing types (ceramic-on-polyethylene [C-PE] ceramic-on-ceramic [COC], and metal-on-polyethylene [M-PE]) from the Medicare 100% inpatient database. Outcomes included relative risk of 30- and 90-day readmission. Propensity scores were developed to adjust for selection bias in the choice of bearing type at index surgery. Cox regression incorporating propensity score stratification (10 levels) was used to evaluate the impact of bearing selection on outcomes, after adjusting for patient-, hospital-, surgeon-related factors, as well as the year of surgery. With C-PE bearings, the unadjusted (crude) 90-day readmission rate decreased from 8.7% in 2010 to 8.3% in 2015. For COC bearings, the crude 90-day readmission rate decreased from 10.5 to 9.1% from 2010 to 2015. After adjustment, year of surgery was associated with reduced readmission risk for both types of ceramic bearings in 30-day readmissions (p < 0.05) and COC in 90-day readmissions (p < 0.001). The authors also found that C-PE bearings were associated with significantly reduced readmission risk relative to M-PE at 30 days (hazard ratio [HR]: 0.91, p < 0.001) and 90 days (HR: 0.93, p < 0.001). In terms of strength of association with 90-day readmission, however, it was ranked the ninth most associated independent factor. To the authors' knowledge, this is the first study to demonstrate an association between THA implant characteristics (in this case C-PE bearing usage) and reduced readmission rates in this context along with patient- and clinical-related factors. The readmission rates for COC were found to be comparable to M-PE.

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Section: Discussionmentioning

confidence: 76%

Ceramic-on-Polyethylene Bearing Usage in Primary THA Is Associated with Reduced Readmission Risk for the Medicare Population

et al. 2018

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“…Reimbursement patterns are significantly influenced by hospital readmissions after total joint arthroplasty. 20 Most recently, the preventability of these readmissions was evaluated in the total hip arthroplasty population [14][15][16] ; however, to our knowledge, a similar study has not been performed among TKA patients. While the risk factors and epidemiology of readmission after arthroplasty have been studied, none has determined the extent to which care during their index admission can determine preventability of a future readmission.…”

Section: Discussionmentioning

confidence: 99%

“…Since many readmissions may not be preventable (on the order of 80% in this study), it may be inappropriate metric by which to penalize hospitals for readmissions under the Affordable Care Act. 16,21 Furthermore, it has been established that more than one-third of the episode-of-care payments for total joint arthroplasty occur during the postdischarge time period, and this has been estimated to be upward of 81% for unplanned readmissions. 22 Bosco et al quantified the cost-burden associated with TKA readmissions as approximately 13,000 U.S. dollars.…”

Section: Discussionmentioning

confidence: 99%

“…This method was implemented in an evaluation of readmissions after total hip arthroplasty which also concluded that very few readmissions are truly preventable in this setting. 16 Final limitations include the variations in operating surgeons' protocols intraoperatively as well as postoperatively, particularly with regard to use of tranexamic acid and anticoagulation, during the study period. This study was performed prior to more recent evidence suggesting that aspirin (ASA) is sufficient for the majority of arthroplasty recipients.…”

Section: Discussionmentioning

confidence: 99%

“…8,12,13 A growing body of literature suggests that only a small proportion of hospital readmissions is likely preventable, 8,14,15 and a recent detailed review of 90-day readmissions after total hip arthroplasty deemed only 4% of total readmissions to be potentially preventable through an intervention that could have occurred during the index hospitalization. 16 We designed this study to answer the following questions: (1) Are unplanned readmissions after TKA associated with orthopaedic or medical causes? (2) Are these readmissions potentially preventable?…”

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confidence: 99%

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Are Readmissions After Total Knee Arthroplasty Preventable?

Copp

Weinberg

et al. 2019

J Knee Surg

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Readmission within 90 days following total joint arthroplasty has become a central quality measure of reimbursement initiatives; however, the validity of readmission rates as a measure of hospital care quality and the proportion of readmissions that are preventable are unknown. The purpose of this study is to determine if readmissions within 30 and 90 days after total knee arthroplasty (TKA) were related to orthopaedic or medical etiology and identify if these readmissions were preventable. We retrospectively reviewed 1,625 elective TKAs performed between 2011 and 2014 at our institution. Readmissions within 30 and 90 days were categorized into orthopaedic and medical etiologies and an expert research panel determined if readmissions were potentially preventable based on objective criteria from national or peer-reviewed consensus guidelines. Out of the 1,625 TKAs performed during the study period, there were a total of 79 (4.8%) readmissions within 90 days of surgery, of which 17 (22%) were of orthopaedic etiology and 62 (78%) were of medical etiology. Fifty-two (66%) of the 79 readmissions occurred within 30 days, with 11 (21%) of orthopaedic and 41 (80%) of medical etiology. Only 2 of 79 (3%) readmissions within 90 days were deemed potentially preventable, and neither of them were orthopaedic in nature. Hospital readmissions after total joint arthroplasty are inevitable; however, only a small percentage (3%) of readmissions to our health care system was potentially preventable. Orthopaedic readmissions constituted a minority of the proportion of readmissions at 30 or 90 days, and none were deemed preventable.

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