Are There Modifiable Risk Factors for Hospital Readmission After Total Hip Arthroplasty in a US Healthcare System?

Abstract

Background Although total hip arthroplasty (THA) is a successful procedure, 4% to 11% of patients who undergo THA are readmitted to the hospital. Prior studies have reported rates and risk factors of THA readmission but have been limited to single-center samples, administrative claims data, or Medicare patients. As a result, hospital readmission risk factors for a large proportion of patients undergoing THA are not fully understood. Questions/purposes (1) What is the incidence of hospital readmissions after primary THA and the reasons for readmission? (2) What are the risk factors for hospital readmissions in a large, integrated healthcare system using current perioperative care protocols? Methods The Kaiser Permanente (KP) Total Joint Replacement Registry (TJRR) was used to identify all patients with primary unilateral THAs registered between January 1, 2009, and December 31, 2011. The KPTJRR's voluntary participation is 95%. A logistic regression model was used to study the relationship of risk factors (including patient, clinical, and system-related) and the likelihood of 30-day readmission. Readmissions were identified using electronic health and claims records to capture readmissions within and outside the system. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. Of the 12,030 patients undergoing primary THAs included in the study, 59% (n = 7093) were women and average patient age was 66.5 years (± 10.7). Results There were 436 (3.6%) patients with hospital readmissions within 30 days of the index procedure. The most common reasons for readmission were infection and inflammatory reaction resulting from internal joint prosthetic (International Classification of Diseases, 9 th Revision, Clinical Modification [ICD-9-CM] 996.66, 7.0%); other postoperative infection (ICD-9-CM 998:59, 5.5%); unspecified septicemia (ICD-9-CM 038.9, 4.9%); and dislocation of a prosthetic joint (ICD-9-CM 996.42, 4.7%). In adjusted models, the following factors were associated with an increased likelihood of 30-day

Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

“…Interestingly, a relatively young age at time of surgery has also been shown to increase readmission rates [11,20] . Male gender resulted in a higher readmission rate in most studies [11,19,23,24] while female gender was the predictor of readmission in another [25] , and associated with a longer LOS [26] . Male gender also predicted a higher complication rate [24] .…”

“…Male gender also predicted a higher complication rate [24] . Obesity resulted in a longer hospital LOS [17,27,28] , readmission rate [19,20,23,27] , and complication rate [21,22,28] . An underweight status has also been shown to increase the rate of readmission [20] .…”

Can Surgeons Adequately Capture Adverse Events Using the Spinal Adverse Events Severity System (SAVES) and OrthoSAVES?

“…Adverse events are becoming increasingly relevant given that the population is aging and postoperative complications increase with age [11,12,15,28,31,32]. Although the clinical importance of minor adverse events is controversial [14], the economic burden should be considered.…”

CORR Insights®: Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

“…In order to determine whether THA bearing surface is associated with PJI risk, an adequately powered registry or insurance database study controlling for all known confounding hospital (high-versus low-volume), surgical (postoperative anticoagulant), and patientrelated factors (BMI) should be conducted [4,5,7]. While a multicenter trial may provide increased data granularity, a prospective study would not allow for adequate examination of MoM THA, and randomization of THA bearing type across surgeons and all patient ages is not feasible.…”