title: The Impact of Risk Reduction Initiatives on Readmission: THA and TKA Readmission Rates.
abstract: We assessed whether sequential incorporation of initiatives to decrease postoperative surgical complications were similarly effective in reducing 30-day readmission rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA). Readmission rates following TKA decreased substantially (5.6% vs. 3.0%, P<0.001), but readmissions following THA (4.0% vs. 3.4%, P=0.41) were not significantly reduced. The greatest impact of the multimodal treatment approach was a reduction of surgically related TKA complications. Advanced medical disease, facility discharge status, and Medicare or Medicaid coverage contributed to the highest risk for 30-day readmission after THA. Risk models defining expected readmission rates should account for these factors to avoid penalizing hospitals that provide higher proportional care to Centers for Medicaid and Medicare Services (CMS) beneficiaries.
authors.affiliation: University of Missouri School of Medicine Department of Orthopaedic Surgery, Columbia, Missouri.
authors.forename: James A
authors.initials: JA
authors.lastname: Keeney
authors.affiliation: Washington University School of Medicine/Barnes-Jewish Hospital Department of Orthopaedic Surgery, St. Louis, Missouri.
authors.forename: Denis
authors.initials: D
authors.lastname: Nam
authors.affiliation: Washington University School of Medicine/Barnes-Jewish Hospital Department of Orthopaedic Surgery, St. Louis, Missouri.
authors.forename: Staci R
authors.initials: SR
authors.lastname: Johnson
authors.affiliation: Washington University School of Medicine/Barnes-Jewish Hospital Department of Orthopaedic Surgery, St. Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
authors.affiliation: Washington University School of Medicine/Barnes-Jewish Hospital Department of Orthopaedic Surgery, St. Louis, Missouri.
authors.forename: John C
authors.initials: JC
authors.lastname: Clohisy
authors.affiliation: Washington University School of Medicine/Barnes-Jewish Hospital Department of Orthopaedic Surgery, St. Louis, Missouri.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Barrack
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D014481:United States / Q000453:epidemiology
keywords: blood transfusion; hospital readmission; length of stay; risk reduction; total hip arthroplasty; total knee arthroplasty