Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty

Abstract

Background Total hip arthroplasty (THA) is a beneficial and cost-effective procedure for patients with osteoarthritis. Recent initiatives to improve hospital quality of care include assessing unplanned hospital readmission rates. Patients presenting for THA have different indications and medical comorbidities that may impact rates of readmission. Questions/purposes This study measured (1) the unplanned hospital readmission rate in primary THA, revision THA, and antibiotic-spacer staged revision THA to treat infection. Additionally, we determined (2) the medical and surgical causes of readmission; and (3) the risk factors associated with unplanned readmission. Methods A total of 1415 patients (988 primary THA, 344 revision THA, 82 antibiotic-spacer staged revision THA to treat infection) from a single institution were included. All hospital readmissions within 90 days of discharge were reviewed. Patient demographics and medical comorbidities were included in a Cox proportional hazards model to assess risk of readmission. Results The overall unplanned readmission rate was 4% at 30 days and 7% at 90 days. At 90 days, primary THA (5%) had a lower unplanned readmission rate than revision THA (10%, p \ 0.001) and antibiotic-spacer staged revision THA (18%, p \ 0.001). Medical diagnoses were responsible for almost one-fourth of unplanned readmissions, whereas over half of surgical readmissions were the result of dislocation, surgical site infection, and postoperative hematoma. Type of procedure, hospital stay greater than 5 days, cardiac valvular disease, diabetes with endorgan complications, and substance abuse were each associated with increased risk of unplanned readmission. Conclusions Higher rates of unplanned hospital readmissions in revision THA rather than primary THA suggest that healthcare quality measures that incorporate readmission rates as a proxy for quality of care should distinguish between primary and revision procedures. Failure to do so may negatively impact tertiary referral hospitals that often care for patients requiring complex revision procedures. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

“…This is low compared with other orthopaedic studies [9,27]. As we would expect with a low incidence of surgical readmission, our medical 30-day readmission rate of 42% is high when compared with other studies [18,20,23].…”

“…Length of stay has been well studied and shown to be a risk factor for readmission in the orthopaedic literature [8,9,22,23,27]. We believe this is because patients typically have longer admissions if they have had a more intense procedure or have other medical conditions requiring treatment, both of which could impart a greater risk of 30-day 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.…”

Increased Rates of Periprosthetic Joint Infection in Patients With Cirrhosis Undergoing Total Joint Arthroplasty

“…As indications for TJA expand and medical care improves, patients undergoing TJAs are from a wider age range and have an increasing number of comorbid medical conditions [11,14]. Because the presence of comorbid medical conditions increases the risk of adverse events and poor outcomes, as more TJAs are performed on an increasingly elderly and medically compromised population, there likely will be an increased number of postoperative complications [12,23,24].…”