Readmission, Reoperation, and Complications: Total Hip vs Total Knee Arthroplasty

George, Jaiben; Chughtai, Morad; Khlopas, Anton; Klika, Alison K.; Barsoum, Wael K.; Higuera, Carlos A.; Mont, Michael A.

doi:10.1016/j.arth.2017.09.048

Cited by 47 publications

(27 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This study found a 30-day hospital readmission rate of 4.28%, which is similar to that reported in other studies. 41,42 It also showed that an increase in age and the number of comorbidities are independent risk factors for hospital re- admission. This is also consistent with other authors' findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

View full text Add to dashboard Cite

show abstract

“…THA and TKA are currently under the same DRG according to the CMS reimbursement schedules. However, George et al suggested that outcomes may differ depending on the procedure 33 . They found that THA cases had significantly higher 30-day readmission and surgical site infection rates compared with TKA cases, even after adjusting for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

et al. 2020

View full text Add to dashboard Cite

Background: The U.S. Patient Protection and Affordable Care Act created the Hospital Readmissions Reduction Program (HRRP) and the Hospital-Acquired Condition Reduction Program (HACRP). Under these programs, hospitals face reimbursement reductions for having high rates of readmission and hospital-acquired conditions. This study investigated whether readmission following total joint arthroplasty (TJA) under the HRRP was associated with reimbursement penalties under the HACRP. Methods: Hospital-level data on hospital-acquired conditions, readmissions, and financial penalties were obtained from Definitive Healthcare. Outcomes included receipt of an HACRP penalty and the associated losses in revenue in 2018. Logistic regression and linear regression models were used to determine whether the all-cause, 30-day readmission rate following TJA was associated with the receipt or magnitude of an HACRP penalty. Results: Among 2,135 private, acute care hospitals, 477 (22.3%) received an HACRP penalty. After controlling for other patient and hospital characteristics, hospitals with a 30-day readmission rate of >3% after TJA had over twice the odds of receiving an HACRP penalty (odds ratio, 2.20; p = 0.043). In addition, hospitals with a readmission rate of >3% after TJA incurred $77,519 more in revenue losses due to HACRP penalties (p = 0.011). These effects were magnified in higher-volume hospitals. Conclusions: Acute care hospitals in the United States with higher 30-day readmission rates following TJA are more likely to be penalized and to have greater revenue losses under the HACRP than hospitals with lower readmission rates after TJA. This strengthens the incentive to invest in the prevention of readmissions after TJA, for example, through greater efforts to reduce surgical site infections and other modifiable risk factors.

show abstract

“…Total joint arthroplasty (TJA) is a successful orthopedic procedure and the full numbers increase year by year [1]. Along with changes of the payment models, it is more and more necessary to reduce postoperative complications and shorten the length of stay [2]. Malnutrition, especially hypoalbuminemia (< 35 g/L), has been found to be an important predictor of complications after total hip arthroplasty (THA) or total knee arthroplasty (TKA) [3], and interventions have also shown that improved albumin levels can reduce the incidence of complications and thus reduce costs [4,5].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Risk Factors Associated with Human Albumin Administration Following Total Joint Arthroplasty.

Zhang¹,

Si²,

Xie³

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundHuman albumin (HA) administration is associated with an increased risk of acute renal failure and most other complications in patients undergoing total hip or knee arthroplasty (THA, TKA). Therefore, it is vital to reduce the use of HA and identify risk factors for its use. This study aims to determine the incidence and risk factors of HA administration in patients undergoing THA or TKA.MethodsWe identified patients undergoing THA or TKA in multiple institutions from 2014 to 2016 and collected patient demographics and perioperative variables. The criterion of HA administration was defined as a postoperative albumin level < 32 g/L or 32 to 35 g/L for at-risk patients. We compared 14 variables between patients who received HA administration and those who did not after stratification by the preoperative albumin (pre-ALB) level. Multivariate regressions identified the independent risk factors associated with HA administration.ResultsIn total, 958 (20.3 %) of 4713 patients undergoing THA and 410 (9.7 %) of 4248 patients undergoing TKA received HA administration. In addition to pre-ALB < 35 g/L, preoperative anemia (odds ratio [OR] 2.12, P = 0.001; OR 1.39, P < 0.001) and drain use (OR 3.33, P = 0.001; OR 4.25, P < 0.001) were also independent risk factors for HA administration after THA regardless pre-ALB < 35 g/L or not, and patients undergoing TKA diagnosed of rheumatoid arthritis or ankylosing spondylitis tended to receive HA administration regardless pre-ALB < 35 g/L or not (OR 3.67, P = 0.002; OR 2.06, P < 0.001).ConclusionThe incidence of HA administration was high in patients undergoing THA or TKA, and several variables were risk factors for HA administration. This finding may aid surgeons in preoperatively identifying patients requiring HA administration and optimizing perioperative managements.

show abstract

Readmission, Reoperation, and Complications: Total Hip vs Total Knee Arthroplasty

Cited by 47 publications

References 37 publications

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Reimbursement Penalties and 30-Day Readmissions Following Total Joint Arthroplasty

Incidence and Risk Factors Associated with Human Albumin Administration Following Total Joint Arthroplasty.

Contact Info

Product

Resources

About