Understanding Readmission After Primary Total Hip and Knee Arthroplasty: Who’s at Risk?

Saucedo, James M.; Marecek, Geoffrey S.; Wanke, Tyler R.; Lee, Jung Hwa; Stulberg, S. David; Puri, Lalit

doi:10.1016/j.arth.2013.06.003

Cited by 144 publications

(102 citation statements)

References 29 publications

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“…The most common reasons for readmission after arthroplasty relate to complications after surgery [15,16,18], so higher complication rates in patients who are insulin dependent would logically explain our results. Although a secondary finding, we noted that neither noninsulin-dependent nor insulindependent diabetes was associated with increased rates of reoperation.…”

Section: Discussionmentioning

confidence: 68%

Do Patients With Insulin-dependent and Noninsulin-dependent Diabetes Have Different Risks for Complications After Arthroplasty?

Lovecchio

Beal

Kwasny

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 68%

Do Patients With Insulin-dependent and Noninsulin-dependent Diabetes Have Different Risks for Complications After Arthroplasty?

Lovecchio

Beal

Kwasny

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…An increased patient age has been shown to result in higher hospital LOS [1517] , readmission rates [15,1820] , increased complication rate [16,21,22] , and disposition to an extended care facility [16] . Interestingly, a relatively young age at time of surgery has also been shown to increase readmission rates [11,20] . Male gender resulted in a higher readmission rate in most studies [11,19,23,24] while female gender was the predictor of readmission in another [25] , and associated with a longer LOS [26] .…”

Section: Discussionmentioning

confidence: 99%

“…Male gender also predicted a higher complication rate [24] . Obesity resulted in a longer hospital LOS [17,27,28] , readmission rate [19,20,23,27] , and complication rate [21,22,28] . An underweight status has also been shown to increase the rate of readmission [20] .…”

Section: Discussionmentioning

confidence: 99%

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Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

Phan

Ahn

Rinehart

et al. 2016

WJO

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AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home (PSH) program. METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were preoperatively stratified based on specific procedure performed, age, gender, body mass index (BMI), American Society of Anesthesiologists Physical Classification System (ASA) score, and Charleston Comorbidity Index (CCI) score. The primary outcome criterion was hospital length of stay (LOS). Secondary criteria including operative room (OR) duration, trans- RESULTS:A total of 337 patients, 200 in the TKA cohort and 137 in the THA cohort, were eligible for the study. Nearly two-third of patients were female. Patient age averaged 64 years and preoperative BMI averaged 29 kg/m 2 . The majority of patients were ASA score Ⅲ and CCI score 0. After analysis, ASA score was the only variable predictive for LOS (P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d. ASA score was also the only variable predictive for readmission rate (P = 0.0332). BMI was the only variable predictive for PACU duration (P = 0.0136). Specific procedure performed, age, gender, and CCI score were not predictive for any of the outcome criteria. OR duration, transfusion rate, postoperative complications or discharge disposition were not significantly associated with any of the predictor variables. CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.

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“…Concerns exist about bundling revision arthroplasty because of a complex and heterogeneous patient population, higher rate of complications, and substantial variability and difficulty in surgical cases. Bundling all postoperative care within 90 day is of particular concern in revisions, because a substantial proportion of readmissions are the result of medical issues unrelated to the index surgical procedure [17].…”

Section: Introductionmentioning

confidence: 99%

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

Courtney

Ashley

Hume

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Alternative payment models, such as the Centers for Medicare & Medicaid Services (CMS) Bundled Payment for Care Improvement (BPCI) initiative, aim to decrease overall costs for hip and knee arthroplasties. Questions/purposes We asked: (1) Is there any difference in the CMS episode-of-care costs, hospital length of stay, and readmission rate from before and after implementation of our bundled-payment program? (2) Is there any difference in reimbursements and resource utilization between revision THA and TKA at our institution? (3) Are there any independent risk factors for patients with high costs who may not be appropriate for a bundled-payment system for revision total joint arthroplasty (TJA)? Methods Between October 2013 and March 2015, 218 patients underwent revision TKA or THA in one health system. Two hundred seventeen patients were reviewed as part of this study, and one patient with hemophilia was excluded from the analysis as an outlier. Our institution began a BPCI program for revision TJA during this study period. Patients' procedures done before January 1, 2014 at one hospital and January 1, 2015 at another hospital were not included in the bundled-care arrangement (70 revision TKAs and 56 revision THAs), whereas 50 revision TKAs and 41 revision THAs were performed under the BPCI initiative. Patient demographics, medical comorbidities, episode-of-care reimbursement data derived directly from CMS, length of stay, and readmission proportions were compared between the bundled and nonbundled groups. Results Length of stay in the group that underwent surgery before the bundled-care arrangement was longer than for patients whose procedures were done under the BPCI (mean 4.02 [SD, 3.0

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Understanding Readmission After Primary Total Hip and Knee Arthroplasty: Who’s at Risk?

Cited by 144 publications

References 29 publications

Do Patients With Insulin-dependent and Noninsulin-dependent Diabetes Have Different Risks for Complications After Arthroplasty?

Do Patients With Insulin-dependent and Noninsulin-dependent Diabetes Have Different Risks for Complications After Arthroplasty?

Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

Are Bundled Payments a Viable Reimbursement Model for Revision Total Joint Arthroplasty?

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