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Clinical Orthopaedics and Related Research®

Published in:

01-02-2014 | Symposium: 2013 Hip Society Proceedings

Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty

Authors: William W. Schairer, MD, David C. Sing, BS, Thomas P. Vail, MD, Kevin J. Bozic, MD, MBA

Published in: Clinical Orthopaedics and Related Research® | Issue 2/2014

Abstract

Background

Total hip arthroplasty (THA) is a beneficial and cost-effective procedure for patients with osteoarthritis. Recent initiatives to improve hospital quality of care include assessing unplanned hospital readmission rates. Patients presenting for THA have different indications and medical comorbidities that may impact rates of readmission.

Questions/purposes

This study measured (1) the unplanned hospital readmission rate in primary THA, revision THA, and antibiotic-spacer staged revision THA to treat infection. Additionally, we determined (2) the medical and surgical causes of readmission; and (3) the risk factors associated with unplanned readmission.

Methods

A total of 1415 patients (988 primary THA, 344 revision THA, 82 antibiotic-spacer staged revision THA to treat infection) from a single institution were included. All hospital readmissions within 90 days of discharge were reviewed. Patient demographics and medical comorbidities were included in a Cox proportional hazards model to assess risk of readmission.

Results

The overall unplanned readmission rate was 4% at 30 days and 7% at 90 days. At 90 days, primary THA (5%) had a lower unplanned readmission rate than revision THA (10%, p < 0.001) and antibiotic-spacer staged revision THA (18%, p < 0.001). Medical diagnoses were responsible for almost one-fourth of unplanned readmissions, whereas over half of surgical readmissions were the result of dislocation, surgical site infection, and postoperative hematoma. Type of procedure, hospital stay greater than 5 days, cardiac valvular disease, diabetes with end-organ complications, and substance abuse were each associated with increased risk of unplanned readmission.

Conclusions

Higher rates of unplanned hospital readmissions in revision THA rather than primary THA suggest that healthcare quality measures that incorporate readmission rates as a proxy for quality of care should distinguish between primary and revision procedures. Failure to do so may negatively impact tertiary referral hospitals that often care for patients requiring complex revision procedures.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE. Is administratively coded comorbidity and complication data in total joint arthroplasty valid? Clin Orthop Relat Res. 2013;471:201–205.PubMedCrossRef

Bozic KJ, Maselli J, Pekow PS, Lindenauer PK, Vail TP, Auerbach AD. The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Joint Surg Am. 2010;92:2643–2652.PubMedCrossRef

Cram P, Lu X, Kaboli PJ, Vaughan-Sarrazin MS, Cai X, Wolf BR, Li Y. Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. JAMA. 2011;305:1560–1567.PubMedCentralPubMedCrossRef

de Vries LM, Sturkenboom MC, Verhaar JA, Kingma JH, Stricker BH. Complications after hip arthroplasty and the association with hospital procedure volume. Acta Orthop. 2011;82:545–552.PubMedCrossRef

Duncan CP, Masri BA. The role of antibiotic-loaded cement in the treatment of an infection after a hip replacement. Instr Course Lect. 1995;44:305–313.PubMed

Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.PubMedCrossRef

Iezzoni LI. Examining the validity of severity measures in today’s health policy context. J Gen Intern Med. 1995;10:406–408.PubMedCrossRef

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360:1418–1428.PubMedCrossRef

Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–1497.PubMedCrossRef

10.

Larsen K, Hansen TB, Thomsen PB, Christiansen T, Soballe K. Cost-effectiveness of accelerated perioperative care and rehabilitation after total hip and knee arthroplasty. J Bone Joint Surg Am. 2009;91:761–772.PubMedCrossRef

11.

Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2003;85:27–32.PubMed

12.

Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002;96:1140–1146.PubMedCrossRef

13.

Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S. Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord. 2011;12:222.PubMedCentralPubMedCrossRef

14.

Marshall DA, Wasylak T, Khong H, Parker RD, Faris PD, Frank C. Measuring the value of total hip and knee arthroplasty: considering costs over the continuum of care. Clin Orthop Relat Res. 2012;470:1065–1072.PubMedCrossRef

15.

Medicare Payment Advisory Commission (MedPAC). Medicare Payment Policy. Washington, DC, USA: Medicare Payment Advisory Commission (MedPAC); 2012.

16.

Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.PubMedCrossRef

17.

Pulido L, Parvizi J, Macgibeny M, Sharkey PF, Purtill JJ, Rothman RH, Hozack WJ. In hospital complications after total joint arthroplasty. J Arthroplasty. 2008;23:139–145.PubMedCrossRef

18.

Quintana JM, Arostegui I, Escobar A, Azkarate J, Goenaga JI, Lafuente I. Prevalence of knee and hip osteoarthritis and the appropriateness of joint replacement in an older population. Arch Intern Med. 2008;168:1576–1584.PubMedCrossRef

19.

Rasanen P, Paavolainen P, Sintonen H, Koivisto AM, Blom M, Ryynanen OP, Roine RP. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 2007;78:108–115.PubMedCrossRef

20.

Schairer WW, Carrer A, Deviren V, Hu SS, Takemoto S, Mummaneni P, Chou D, Ames C, Burch S, Tay B, Sawyer A, Berven SH. Hospital readmission after spine fusion for adult spinal deformity. Spine. 2013 May 21 [Epub ahead of print].

21.

Schairer WW, Vail TP, Bozic KJ. What are the rates and causes of hospital readmission after total knee arthroplasty? Clin Orthop Relat Res. 2013 May 4 [Epub ahead of print].

22.

Sepucha KR, Stacey D, Clay CF, Chang Y, Cosenza C, Dervin G, Dorrwachter J, Feibelmann S, Katz JN, Kearing SA, Malchau H, Taljaard M, Tomek I, Tugwell P, Levin CA. Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation. BMC Musculoskelet Disord. 2011;12:149.PubMedCentralPubMedCrossRef

23.

US Department of Health and Human Services. Medicare Hospital Compare Quality of Care. Available at: http://www.hospitalcompare.hhs.gov. Accessed March 15, 2013.

24.

Volpp KG, Loewenstein G, Asch DA. Assessing value in health care programs. JAMA. 2012;307:2153–2154.PubMedCentralPubMed

25.

WHO Regional Office for Europe. Do Current Discharge Arrangements From Inpatient Hospital Care for the Elderly Reduce Readmission Rates, the Length of Inpatient Stay or Mortality, or Improve Health Status? Copenhagen, Denmark: WHO Regional Office for Europe; 2005.

26.

Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007;89:526–533.PubMedCrossRef

Title: Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty
Authors: William W. Schairer, MD
David C. Sing, BS
Thomas P. Vail, MD
Kevin J. Bozic, MD, MBA
Publication date: 01-02-2014
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 2/2014
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-3121-5

At a glance: The STEP trials

Springer Medicine

Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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