Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital.
Total joint arthroplasty procedures continue to provide consistent, long-term success and high patient satisfaction scores. However, early unplanned readmission to the hospital imparts significant financial risks to individual institutions as we shift away from the traditional fee-for-service payment model.



Using a combination of our hospital's administrative database and retrospective chart reviews, we report the 30-day and 90-day readmission rates and all causes of readmission following all unilateral, primary elective total hip and knee arthroplasty procedures at a large, urban, academic hospital from 2004 to 2013.



In total, 1165 primary total hip (511) and knee (654) arthroplasty procedures were identified, and the 30-day and 90-day unplanned readmission rates were 4.6% and 7.3%, respectively. A multivariate regression model controlled for a variety of potential clinical and surgical confounders. Increasing body mass index levels, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each independently correlated with risk of both 30-day and 90-day unplanned readmission to our institution. Additionally, use of general anesthesia during the procedure independently correlated with risk of readmission at 30 days only, while congestive heart failure independently correlated with risk of 90-day unplanned readmission. Readmissions related directly to the surgical site accounted for 47% of the cases, and collectively totaled more than any single medical or clinical complication leading to unplanned readmission within the 90-day period.



Increasing body mass index values, general anesthesia, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each were independent risk factors for early unplanned readmission.
Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Matthew A
MA
Varacallo
Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.
Leah
L
Herzog
Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Nader
N
Toossi
Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.
Norman A
NA
Johanson
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000639:trends; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000639:trends; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006786:Hospitals, Urban / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends*; D015143:Philadelphia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors
bundled payments; primary THA; primary TJA; primary TKA; readmission