Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey

Abstract

ObjectivesThe aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home.Design, setting and participantsA cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders.ResultsOf the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study.ConclusionReasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems.

A systematic review of the accessibility, acceptability, safety, efficiency, clinical effectiveness, and cost-effectiveness of private cataract and orthopedic surgery clinics

“…Clinical effectiveness can be assessed by many outcomes, such as improvements life-years gained, symptom relief, patient-reported outcomes, or cure. Researchers explored postoperative outcomes, readmission rates, reoperation rates, or short-term complications of surgical procedures as a clinical effectiveness factor in eight studies (6; 8;10;11;13;18;33;42). The most extensive research on the correlation between clinical effectiveness and care provider types was conducted in the UK (8;10;11) and Australia (6;13;33;42).…”

“…Researchers explored postoperative outcomes, readmission rates, reoperation rates, or short-term complications of surgical procedures as a clinical effectiveness factor in eight studies (6; 8;10;11;13;18;33;42). The most extensive research on the correlation between clinical effectiveness and care provider types was conducted in the UK (8;10;11) and Australia (6;13;33;42). Results of included studies are summarized by surgery type in Table 2.…”

“…It is worth noting that the variation in revision rates after hip and knee surgeries could be mainly due to differences in prosthesis selection (13). One study found that following total knee arthroplasty, public patients were significantly more likely to be readmitted within 30 days compared with private patients and the authors concluded that these higher readmission rates might be explained by several contributing factors such as socioeconomic status, longer waiting times resulting in increased impairment and disease complexity (42). A recently published study evaluated the preoperative symptom severity and found that patients who underwent primary total hip replacement or total knee replacement for osteoarthritis had significantly worse preoperative symptom severity if their surgery was performed at a public hospital which may reflect variation in access to surgery, and surgeon and patient preferences between these groups (43).…”

Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study

“…Surgeries in the private sector occur sooner than those awaiting surgery through the public health system [ 23 ]. Public patients experiencing increased wait times for arthroplasty in the public health system may result in worse symptoms as well as progression of disease complexity [ 47 , 48 ], which may result in a higher prevalence of opioid use to manage their pain and maintain function. Furthermore, public patients in SWSLHD come from low socioeconomic class [ 49 ], thus increasing the prevalence of opioid use prior to arthroplasty [ 50 ].…”