Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1499-1504
The Journal of Arthroplasty

Incidence of and Risk Factors for 30-Day Readmission Following Elective Primary Total Joint Arthroplasty: Analysis From the ACS-NSQIP

https://doi.org/10.1016/j.arth.2013.06.032Get rights and content

Abstract

Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and 8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. Complications associated with readmission were predominantly wound infections, sepsis, thromboembolic, cardiac, and respiratory related. In TKA, multivariate analysis identified age (P = 0.002), male gender (P = 0.03), cancer history (P = 0.008), elevated BUN (P = 0.002), a bleeding disorder (P < 0.001) and high ASA class (P < 0.001) as predictors of readmission. In THA, obesity (P = 0.008), steroid use (P = 0.037), a bleeding disorder (P = 0.002), dependent functional status (P = 0.022), and high ASA class (P < 0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification.

Section snippets

Data

We used the 2011 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients undergoing primary elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) using a Current Procedural Terminology (CPT) codes 27447 and 27130. The ACS-NSQIP is a HIPPA compliant de-identified database. This study was deemed exempt by the University of Iowa (UI) IRB. No external funding was used in this study.

Thirty-day readmission data within

Results

Overall 30-day readmission rates were 4.6% for TKA and 4.2% for THA. Readmissions were higher in those 65 years and older, 5.18% after TKA and 5.17% after THA, versus those < 65 years, 3.89% (TKA) and 3.34% (THA). Patient demographics in all patients undergoing primary TKA and THA were also reported (Table 1). Average age for patients undergoing TKA was 66.9 years vs 64.8 years in THA. Both cohorts had a similar race distribution, with 80.9% white in TKA and 82.2% white in THA. TKA patients tended

Discussion

Few readmission studies have specifically focused on joint arthroplasty. In this evaluation of the contemporary ACS-NSQIP data we examined the incidence, causes, and risk factors for 30-day readmission after elective primary total joint arthroplasty. We have used non-Medicare data, from a clinical registry with stringent collection methods and nationally accepted quality measures. A number of our findings are noteworthy to both surgeons and policy researchers. First, this study has identified

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    Conflict of Interest Statement: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

    Ethical Review Committee Statement: This study received an exemption by the institutional review board at the University of Iowa.

    Source of Funding: There was no external source of funding for this study.

    Disclosure: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.06.032.

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