Thirty-Day Unplanned Readmission after Total Knee Arthroplasty at a Teaching Community Hospital: Rates, Reasons, and Risk Factors

Abstract

Unplanned readmission after total knee arthroplasty (TKA) has an increasing prevalence in the United States. Readmissions are now a metric for hospital quality of care, yet there are mixed results and variables associated with unplanned readmission. In this changing healthcare, it is critical for community healthcare institutions to identify risk factors for unplanned readmissions following TKA. Retrospective chart review and a hospital administrative database query to report causes, demographics, and medical comorbid risk factors result in 30-day readmission after undergoing primary TKA between 2011 and 2016 at a teaching community hospital. This study identified 7,482 primary TKA procedures of which 210 (2.8%) were unplanned readmissions. Gastrointestinal bleed (9.05%) and periprosthetic infection (8.10%) were the most common causes of readmission. Age 65 and older (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.21–2.21; p = 0.0012), male (OR, 1.37; 95% CI, 1.03–1.83; p = 0.0302), length of stay > 3 days (OR, 2.04; 95% CI, 1.45–2.86; p < 0.0001), and discharge to rehab (OR, 2.21; 95% CI, 1.49–3.26; p ≤ 0.0001) were correlated significantly with risk of 30-day readmission. Chronic airway disease (OR, 2.81; 95% CI, 1.54–5.14; p = 0.0008) and obesity (OR, 1.45; 95% CI, 1.006–2.10; p = 0.0463) were significant risk factors. Higher Charlson comorbidity index was not a predictor of time to readmission within 30 days after TKA.

Keywords

total knee arthroplasty - readmission - total joint arthroplasty - medical comorbidities

• References

• 1 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
• 2 National Quality Measures Clearinghouse. Total hip arthroplasty (THA) and/or total knee arthroplasty (TKA): hospital-level 30-day, all-cause, unplanned risk-standardized readmission rate (RSRR) following elective primary THA and/or TKA. Specifications manual for national hospital inpatient quality measures, version 4.2bCenter for Medicare and Medicaid Services (CMS). The Joint Commission 2013
• 3 Kurtz SM, Ong KL, Schmier J. , et al. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am 2007; 89 (Suppl. 03) 144-151
• 4 Centers for Medicare and Medicaid Services. Comprehensive care for joint replacement model. https://innovation.cms.gov/initiatives/cjr 2017 [accessed 17 January 2018].
• 5 Cram P, Lu X, Kaboli PJ. , et al. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008. JAMA 2011; 305 (15) 1560-1567
• 6 Higuera CA, Elsharkawy K, Klika AK, Brocone M, Barsoum WK. 2010 Mid-America Orthopaedic Association Physician in Training Award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 2011; 469 (05) 1391-1400
• 7 Jørgensen CC, Kehlet H. ; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Role of patient characteristics for fast-track hip and knee arthroplasty. Br J Anaesth 2013; 110 (06) 972-980
• 8 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
• 9 Pugely AJ, Callaghan JJ, Martin CT, Cram P, Gao Y. Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplasty 2013; 28 (09) 1499-1504
• 10 Zmistowski B, Restrepo C, Hess J, Adibi D, Cangoz S, Parvizi J. Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. J Bone Joint Surg Am 2013; 95 (20) 1869-1876
• 11 Varacallo MA, Herzog L, Toossi N, Johanson NA. Ten-Year trends and independent risk factors for unplanned readmission following elective total joint arthroplasty at a large urban academic hospital. J Arthroplasty 2017; 32 (06) 1739-1746
• 12 Vorhies JS, Wang Y, Herndon JH, Maloney WJ, Huddleston JI. Decreased length of stay after TKA is not associated with increased readmission rates in a national Medicare sample. Clin Orthop Relat Res 2012; 470 (01) 166-171
• 13 Avram V, Petruccelli D, Winemaker M, de Beer J. Total joint arthroplasty readmission rates and reasons for 30-day hospital readmission. J Arthroplasty 2014; 29 (03) 465-468
• 14 Lalmohamed A, Vestergaard P, Javaid MK. , et al. Risk of gastrointestinal bleeding in patients undergoing total hip or knee replacement compared with matched controls: a nationwide cohort study. Am J Gastroenterol 2013; 108 (08) 1277-1285
• 15 Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012; 94 (20) 1839-1844
• 16 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
• 17 Bini SA, Fithian DC, Paxton LW, Khatod MX, Inacio MC, Namba RS. Does discharge disposition after primary total joint arthroplasty affect readmission rates?. J Arthroplasty 2010; 25 (01) 114-117
• 18 Zmistowski B, Hozack WJ, Parvizi J. Readmission rates after total hip arthroplasty. JAMA 2011; 306 (08) 825 , author reply 825–826
• 19 Raines BT, Ponce BA, Reed RD, Richman JS, Hawn MT. Hospital acquired conditions are the strongest predictor for early readmission: an analysis of 26,710 arthroplasties. J Arthroplasty 2015; 30 (08) 1299-1307