title: Patterns of Ninety-Day Readmissions Following Total Joint Replacement in a Bundled Payment Initiative.
abstract: Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis.
  
  
  
  A retrospective cohort of 80 readmissions out of 1412 total joint replacement patients reimbursed through a bundled payment plan was analyzed. Patients were grouped by readmission diagnosis (surgical or medical) and the main variables analyzed were time to readmission, location of readmission, and baseline Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores capturing pre-existing state of health. Nonparametric tests and multivariable regressions were used to test associations.
  
  
  
  Surgical readmissions occurred earlier than medical readmissions (mean 18 vs 33 days, P = .011), and were more likely to occur at the hospital where the surgery was performed (P = .035). Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores did not predict medical vs surgical readmissions (P = .466 and .879) after adjusting for confounding variables.
  
  
  
  Readmissions appear to follow different patterns depending on whether they are surgical or medical. Surgical readmissions occur earlier than medical readmissions, and more often at the hospital where the surgery was performed. The results of this study suggest that these 2 types of readmissions have different patterns with different implications toward perioperative care and follow-up after total joint replacement.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Behery
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Kester
authors.affiliation: New York University School of Medicine, New York, New York.
authors.forename: Jarrett
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: James D
authors.initials: JD
authors.lastname: Slover
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006761:Hospitals; D006801:Humans; D008297:Male; D064872:Patient Care Bundles / Q000191:economics*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011184:Postoperative Period; D012189:Retrospective Studies
keywords: bundled payment plan; medical complications; readmission; surgical complications; timing of readmissions; total joint replacement