Readmission due to infection following total hip and total knee procedures

Abstract

Policymakers have expanded readmissions penalty programs to include elective arthroplasties, but little is known about the risk factors for readmissions following these procedures. We hypothesized that infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) lead to excess readmissions and increased costs. This study aims to evaluate the proportion of readmissions due to infections following THA and TKA.Healthcare Cost and Utilization Project–State Inpatient Databases were used for the study. Procedure codes “8151” and “8154” were used to identify inpatient discharges with THA and TKA in Florida (FL) 2009 to 2013, Massachusetts (MA) 2010 to 2012, and California (CA) 2009 to 2011. Readmission was measured by a Centers for Medicare and Medicaid Services (CMS) validated algorithm. Infections were identified by ICD-9-CM codes: 99859, 99666, 6826, 0389, 486, 4821, 00845, 5990, 48242, 04111, 04112, 04119, 0417, 99591, and 99592. Descriptive analysis was performed.In CA, 4.29% of patients were readmitted with 33.02% of the total readmissions for infection. In FL, 4.7% of patients were readmitted with 33.39% of the readmissions for infection. In MA, 3.92% of patients were readmitted with 35.2% of readmissions for infection. Of the total number of readmissions due to infection, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) together accounted for 14.88% in CA, 13.38% in FL, and 13.11% in MA.The rate of infection is similar across all 3 states and is a leading cause for readmission following THA and TKA. Programs to reduce the likelihood of MRSA or MSSA infection would reduce readmissions due to infection.

Fascia and soft tissues innervation in the human hip and their possible role in post‐surgical pain

“…Gáspár et al 10 suggested that pre‐ and post‐operative pain in osteoarthritis is not correlated with the density of nerve fibers found in the capsule. Some authors have reported better post‐operative satisfaction (Harris Hip Score) in cases in which the capsule was preserved and repaired, with respect to cases in which the capsule was removed, but this difference disappeared 6 months post‐operatively 12 . The ligamentum teres also seems to play a role as a pain generator and joint lubricator 13,14 .…”

Risk factors for periprosthetic joint infection following total hip and knee arthroplasty

“…In California (from 2009 to 2011), 4.29% of patients were readmitted with 33.02% recorded readmissions due to infection 65 . In Florida (from 2009 to 2013), 4.7% of patients were readmitted with 33.39% of patients diagnosed with septic arthritis 65 .…”

“…In California (from 2009 to 2011), 4.29% of patients were readmitted with 33.02% recorded readmissions due to infection 65 . In Florida (from 2009 to 2013), 4.7% of patients were readmitted with 33.39% of patients diagnosed with septic arthritis 65 . In Massachusetts (from 2010 to 2012), 3.92% of patients were readmitted with 35.2% for periprosthetic joint infection 65 .…”

“…In Florida (from 2009 to 2013), 4.7% of patients were readmitted with 33.39% of patients diagnosed with septic arthritis 65 . In Massachusetts (from 2010 to 2012), 3.92% of patients were readmitted with 35.2% for periprosthetic joint infection 65 . Staphylococcus Aureus was the most usual cultivated pathogen from septic samples 65 .…”

“…In Massachusetts (from 2010 to 2012), 3.92% of patients were readmitted with 35.2% for periprosthetic joint infection 65 . Staphylococcus Aureus was the most usual cultivated pathogen from septic samples 65 .…”