What Are the Rates and Causes of Hospital Readmission After Total Knee Arthroplasty?

Abstract

Background Total knee arthroplasty (TKA) and related interventions such as revision TKA and the treatment of infected TKAs are commonly performed procedures. Hospital readmission rates are used to measure hospital performance, but risk factors (both medical and surgical) for readmission after TKA, revision TKA, and treatment for the infected TKA have not been well characterized. Questions/purposes We measured (1) the unplanned hospital readmission rate in primary TKA and revision TKA, including antibiotic-spacer staged revision TKA to treat infection. We also evaluated (2) the medical and surgical causes of readmission and (3) risk factors associated with unplanned hospital readmission. Methods This retrospective cohort study included a total of 1408 patients (1032 primary TKAs, 262 revision TKAs, 113 revision of infected TKAs) from one institution. All hospital readmissions within 90 days of discharge were evaluated for timing and cause. Diagnoses at readmission were categorized as surgical or medical. Readmission risk was assessed using a Cox proportional hazards model that incorporated patient demographics and medical comorbidities. Results The unplanned readmission rate for the entire cohort was 4% at 30 days and 8% at 90 days. At 90 days postoperatively, revision of an infected TKA had the highest readmission rate, followed by revision TKA, with primary TKA having the lowest rate. Approximately threefourths of readmissions were the result of surgical causes, mostly infection, arthrofibrosis, and cellulitis, whereas the remainder of readmissions were the result of medical causes. Procedure type (primary TKA versus revision TKA or staged treatment for infected TKA), hospital stay more than 5 days, discharge destination, and a fluid/electrolyte abnormality were each associated with risk of unplanned readmission.

Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA

“…Identifying the mechanisms of failure in revision joint arthroplasties is critical to guiding efforts to improve clinical outcomes. Beyond clinical demands associated with revisions, the increasing economic burden of these procedures creates financial strains for surgeons, patients, and health systems [23,47,48]. These data may be important for healthcare systems to appropriately allocate resources in arthroplasty service lines: The revision burden for THA is greater than for TKA, but revision TKAs are increasing at a faster rate.…”

Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty

“…In studies that also used detailed medical record review, medical complications contributed to 18% of unplanned readmissions after spine fusion for adult spinal deformity and 25% of readmissions after TKA [20,21]. Jencks et al [8] also found multiple different causes of hospital readmission after major hip or knee surgery, but as a result of the use of administrative claims data, the authors did not delineate all causes of readmission.…”

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

“…Patients undergoing orthopaedic surgery often have multiple coexisting medical conditions (comorbidities) [13,21,24,28,39,45,58]. Preoperative risk assessment can help with decision-making and management strategies [11,37,50].…”