title: Socioeconomically Disadvantaged CMS Beneficiaries Do Not Benefit From the Readmission Reduction Initiatives.
abstract: We assessed the impact of minority and socioeconomic status on 30-day readmission rates after 3825 primary total hip arthroplasty (THA) and 3118 primary total knee arthroplasty (TKA) procedures. Minority patients had higher THA (7.4% vs 3.2%, P=0.001) and TKA (5.4% vs 3.7%, P<0.001) readmission rates. Low socioeconomic status was associated with higher THA (6.0% vs 3.1%, P<0.001) and TKA (6.3% vs 3.8%, P=0.02) readmission rates. Risk reduction initiatives were effective after TKA, but minority status and low socioeconomic status were still associated with higher 30-day readmission rates (4.6% vs 1.8%, P<0.01). Focused postoperative engagement for Centers for Medicare and Medicaid Services (CMS) beneficiaries less than 65 years of age may help reduce complications and 30-day readmissions.
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data*; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011184:Postoperative Period; D012959:Socioeconomic Factors; D014481:United States; D035862:Vulnerable Populations
keywords: THA; TKA; minority; readmission; socioeconomic