title: Disparities in 30-Day Readmissions After Total Hip Arthroplasty.
abstract: BACKGROUND
  Policymakers have expanded readmissions penalties to include elective total hip arthroplasties (THA), but little is known whether disparities exist on the basis of race, socioeconomic status, or payer.
  
  
  OBJECTIVE
  To identify disparities in elective primary THA readmissions based on race, socioeconomic status, and type of insurance.
  
  
  METHODS
  This analysis is a retrospective cohort study of patients discharged for an elective THA. The Healthcare Cost & Utilization Project's State Inpatient Database from California was used to identify index hospitalizations for elective primary THA and rehospitalizations within 30 days of discharge. We used multivariate logistic regression to examine differences in readmissions by race, socioeconomic status, and insurance.
  
  
  METHODS
  Subjects included patients discharged from California hospitals from 2009 through 2011 after THA.
  
  
  METHODS
  Risk-adjusted odds of all-cause 30-day readmission.
  
  
  RESULTS
  The overall rate of unplanned 30-day all-cause readmissions was 4.6%. African American [odds ratio (OR)=1.38; 95% confidence interval (CI), 1.16-1.64] and Hispanic (OR=1.16; 95% CI, 1.00-1.34) patients had a higher risk of readmission than white patients after THA, when accounting for comorbidities and hospital factors. The observed difference for Hispanic patients, however, was null after adjusting for socioeconomic status and payer. Lower socioeconomic status was associated with higher odds of readmission (OR=1.24; 95% CI, 1.10-1.39). Compared with private insurance, Medicare (OR=1.26; 95% CI, 1.13-1.43), Medicaid (OR=1.86; 95% CI, 1.49-2.32), and uninsured status (OR=1.31; 95% CI, 1.01-1.69) were also associated with increased readmission risk.
  
  
  CONCLUSIONS
  We found significant differences in the odds of 30-day readmissions on the basis of race, socioeconomic status, and payer. As readmissions penalties become widely adopted, payers need to be mindful of their effects on vulnerable populations.
authors.affiliation: *Tulane University School of Medicine and School of Public Health & Tropical Medicine †Department of Global Health Systems and Development, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA.
authors.forename: Carlos Irwin A
authors.initials: CI
authors.lastname: Oronce
authors.forename: Hui
authors.initials: H
authors.lastname: Shao
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012959:Socioeconomic Factors