Aims Although readmission has historically been of primary interest, emergency department (ED) visits are increasingly a point of focus and can serve as a potentially unnecessary gateway to readmission. This study aims to analyze the difference between primary and revision total joint arthroplasty (TJA) cases in terms of the rate and reasons associated with 90-day ED visits. Methods We retrospectively reviewed all patients who underwent TJA from 2011 to 2021 at a single, large, tertiary urban institution. Patients were separated into two cohorts based on whether they underwent primary or revision TJA (rTJA). Outcomes of interest included ED visit within 90-days of surgery, as well as reasons for ED visit and readmission rate. Multivariable logistic regressions were performed to compare the two groups while accounting for all statistically significant demographic variables. Results Overall, 28,033 patients were included, of whom 24,930 (89%) underwent primary and 3,103 (11%) underwent rTJA. The overall rate of 90-day ED visits was significantly lower for patients who underwent primary TJA in comparison to those who underwent rTJA (3.9% vs 7.0%; p < 0.001). Among those who presented to the ED, the readmission rate was statistically lower for patients who underwent primary TJA compared to rTJA (23.5% vs 32.1%; p < 0.001). Conclusion ED visits present a significant burden to the healthcare system. Patients who undergo rTJA are more likely to present to the ED within 90 days following surgery compared to primary TJA patients. However, among patients in both cohorts who visited the ED, three-quarters did not require readmission. Future efforts should aim to develop cost-effective and patient-centred interventions that can aid in reducing preventable ED visits following TJA. Cite this article: Bone Jt Open 2022;3(7):543–548.
Introduction: Advanced age is considered a major risk factor for postoperative complications in total hip arthroplasty (THA). Consequently, older patients undergoing THA may require more detailed pre-procedural examinations and more healthcare resources postoperatively than younger patients. The purpose of this study was to compare discharge parameters and complication rates of THA in patients ⩾90 years old to those <90 years old. Methods: A retrospective review of 14,824 THA patients from 2011 to 2021 at a high-volume, urban academic centre was conducted. Patients ⩾90 years old were propensity-matched to a control group of patients aged <90 years old. Patient demographics, surgical time, hospital length of stay (LOS), discharge disposition, and 90-day revision, readmission, and mortality rates were collected. Demographic differences and outcomes were assessed using chi-square and independent sample t-tests. Results: After propensity matching, the average age in the younger cohort (YC, n = 54) was 75.81 ± 7.89, and 91.61 ± 1.73 for the older cohort (OC, n = 54). The OC had a longer LOS than the YC (mean 3.90 vs. 3.06 days; p = 0.031). Discharge disposition significantly differed ( p = 0.007); older patients were more likely to be discharged to skilled nursing facilities (33.3% vs. 14.8%) or acute rehabilitation centres (14.8% vs. 3.7%) and less likely to be discharged to prior place of residence (home self-managed/home with services, 51.9% vs. 79.6%). There was no significant difference in surgical time (93.87 ± 29.75 vs. 96.09 ± 26.31 min; p = 0.682), 90-day revision rate (3.7% vs. 0%; p = 0.153), 90-day readmission rate (9.4% vs. 3.7%; p = 0.543), and 90-day mortality rate (1.9% vs. 1.9%; p = 1.000). Conclusions: Although THA patients over 90 years of age had a longer LOS and differing discharge disposition, these patients had similar complications compared to their younger counterparts. Thus, our study supports similar efficacy of THA in patients 90 years and older relative to younger THA candidates.
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