title: When do readmissions for infection occur after spine and total joint procedures?
abstract: BACKGROUND
  The episode-of-care concept promulgated by the federal government requires hospitals to assume the cost burden for all care rendered up to 30 days after discharge, including all readmissions occurring in that time. Although surgical site infections (SSIs) are a leading cause of readmission after total joint arthroplasties (TJA) and spine surgery, it is unclear whether these readmissions occur relative to the 30-day period.
  
  
  OBJECTIVE
  We determined whether (1) most readmissions for SSIs occurred in 30 days, (2) the type of procedure performed affected the timing of readmission, and (3) the type of infecting organism influenced the timing of readmission.
  
  
  METHODS
  From our hospital database we identified 91 patients treated with elective TJAs and spine surgery from 2007 through 2010 who were readmitted with SSIs. Of the 91 patients, 46 had undergone spine surgery and 45 had TJAs. For each of these readmissions, we determined the type of surgery, the length of time from initial discharge to readmission, and the type of infecting organism.
  
  
  RESULTS
  Readmissions after spine surgery were more likely to occur within 30 days of discharge (80.4% for spine, 58.3% for TJAs). In the TJA cohort, there was a trend toward readmissions occurring within 30 days of discharge more often in the THA subset. We identified no correlation between type of infecting organism and timing of readmission.
  
  
  CONCLUSIONS
  With the episode-of-care model, SSIs pose a substantial cost burden for hospitals since the majority would be included in the 30-day period included in the bundled reimbursement.
authors.affiliation: New York University Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY 10003, USA.
authors.forename: Elliot
authors.initials: E
authors.lastname: Nacke
authors.forename: Nikko
authors.initials: N
authors.lastname: Ramos
authors.forename: Spencer
authors.initials: S
authors.lastname: Stein
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hutzler
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000191:economics; D016208:Databases, Factual; D006761:Hospitals; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000191:economics; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D013530:Surgical Wound Infection / Q000191:economics / Q000628:therapy*; D013997:Time Factors