Top

International Orthopaedics

Published in:

01-01-2018 | Original Paper

Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre

Authors: Sami A. Saku, Rami Madanat, Tatu J. Mäkinen

Published in: International Orthopaedics | Issue 1/2018

Abstract

Purpose

We aimed to assess the rates, reasons, and risk factors for 90-day re-admissions after total knee arthroplasty (TKA) in a European healthcare setting.

Methods

We identified all primary elective TKA procedures performed in 2015 at a single high-volume centre. Patients with unplanned re-admissions within 90 days of primary discharge were compared to a 1:4 control cohort of patients having no relevant re-admission. We calculated re-admission rates, recorded the reasons for re-admission, and identified independent predictors of re-admission.

Results

The 30-day and 90-day unplanned re-admission rates were 6.5% and 8.0%, respectively. The most common reason for re-admission within 90 days was infection (29.6%), followed by knee pain (14.1%), gastrointestinal complications (8.5%), and haematoma (8.5%). Multivariable logistic regression analysis revealed that the following factors were significant independent predictors of re-admission: asthma, psychiatric disease, pre-operative tibiofemoral valgus angle, and pre-operative knee flexion deficit.

Conclusions

The re-admission rates in our health-care setting were slightly higher than those previously reported. Independent risk factors for re-admissions included pre-operative mechanical axis, range of motion, asthma, and psychiatric disease. Our present results will facilitate the targeting of new subgroups of TKA patients when developing new interventions to further reduce the total re-admission risk after TKA.

Kurtz SM, Ong KL, Lau E, Bozic KJ (2014) Impact of the economic downturn on total joint replacement demand in the United States. J Bone Joint Surg Am 96:624–630. https://doi.org/10.2106/JBJS.M.00285 CrossRefPubMed

Ricciardi BF, Oi KK, Daines SB, Lee Y-Y, Joseph AD, Westrich GH (2016) Patient and perioperative variables affecting 30-day readmission for surgical complications after hip and knee Arthroplasties: a matched cohort study. J Arthroplast. https://doi.org/10.1016/j.arth.2016.10.019

Avram V, Petruccelli D, Winemaker M, de Beer J (2014) Total joint arthroplasty readmission rates and reasons for 30-day hospital readmission. J Arthroplast 29:465–468. https://doi.org/10.1016/j.arth.2013.07.039 CrossRef

Ramkumar PN, Chu CT, Harris JD, Athiviraham A, Harrington MA, White DL et al (2015) Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop (Belle Mead NJ) 44:397–405

Bini SA, Inacio MCS, Cafri G (2015) Two-day length of stay is not inferior to 3 days in total knee arthroplasty with regards to 30-day readmissions. J Arthroplast 30:733–738. https://doi.org/10.1016/j.arth.2014.12.006 CrossRef

Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT (2016) Which hospital and clinical factors drive 30- and 90-day readmission after TKA? J Arthroplast 31:2099–2107. https://doi.org/10.1016/j.arth.2016.03.045 CrossRef

Husted H, Jørgensen CC, Gromov K, Kehlet H, on behalf of the Lundbeck Foundation Center for Fast-track Hip and Knee Replacement Collaborative Group (2016) Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty? Acta Orthop. https://doi.org/10.1080/17453674.2016.1203477

Raines BT, Ponce BA, Reed RD, Richman JS, Hawn MT (2014) Hospital acquired conditions are the strongest predictor for early readmission: an analysis of 26,710 arthroplasties. J Arthroplast 30:1299–1307. https://doi.org/10.1016/j.arth.2015.02.024. CrossRef

Schairer WW, Vail TP, Bozic KJ (2014) What are the rates and causes of hospital readmission after total knee arthroplasty? Clin Orthop Relat Res 472:181–187. https://doi.org/10.1007/s11999-013-3030-7 CrossRefPubMed

10.

Zmistowski B, Restrepo C, Hess J, Adibi D, Cangoz S, Parvizi J (2013) Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. J Bone Joint Surg Am 95:1869–1876. https://doi.org/10.2106/JBJS.L.00679 CrossRefPubMed

11.

Pugely AJ, Callaghan JJ, Martin CT, Cram P, Gao Y (2013) Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplast 28:1499–1504. https://doi.org/10.1016/j.arth.2013.06.032 CrossRef

12.

Weinberg DS, Kraay MJ, Fitzgerald SJ, Sidagam V, Wera GD (2017) Are readmissions after THA preventable? Clin Orthop Relat Res 475(5):1414–1423. https://doi.org/10.1007/s11999-016-5156-x

13.

Sibia US, Mandelblatt AE, Callanan MA, MacDonald JH, King PJ (2017) Incidence, risk factors, and costs for hospital returns after total joint arthroplasties. J Arthroplast 32:381–385. https://doi.org/10.1016/j.arth.2016.08.003 CrossRef

14.

Vorhies JS, Wang Y, Herndon JH, Maloney WJ, Huddleston JI (2012) Decreased length of stay after TKA is not associated with increased readmission rates in a national medicare sample. Clin Orthop Relat Res 470:166–171. https://doi.org/10.1007/s11999-011-1957-0 CrossRefPubMed

15.

Lavernia CJ, Villa JM, Iacobelli DA (2013) Readmission rates in the state of Florida: a reflection of quality? Clin Orthop Relat Res 471:3856–3862. https://doi.org/10.1007/s11999-013-2849-2 CrossRefPubMedPubMedCentral

16.

Sund R (2012) Quality of the Finnish hospital discharge register: a systematic review. Scand J Public Health 40:505–515. https://doi.org/10.1177/1403494812456637 CrossRefPubMed

17.

Insall JN, Dorr LD, Scott RD, Scott WN (1989) Rationale of the knee society clinical rating system. Clin Orthop Relat Res 248:13–14

18.

Saucedo JM, Marecek GS, Wanke TR, Lee J, Stulberg SD, Puri L (2013) Understanding readmission after primary total hip and knee arthroplasty: who’s at risk? J Arthroplast 29:256–260. https://doi.org/10.1016/j.arth.2013.06.003. CrossRef

19.

Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C (2016) Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplast 31:2385–2388. https://doi.org/10.1016/j.arth.2016.04.010 CrossRef

20.

Klement MR, Bala A, Blizzard DJ, Wellman SS, Bolognesi MP, Seyler TM (2016) Should we think twice about psychiatric disease in total hip arthroplasty? J Arthroplast 31:S221–S226. https://doi.org/10.1016/j.arth.2016.01.063 CrossRef

21.

Boylan MR, Perfetti DC, Elmallah RK, Krebs VE, Paulino CB, Mont MA (2016) Does chronic corticosteroid use increase risks of readmission, thromboembolism, and revision after THA? Clin Orthop Relat Res 474:744–751. https://doi.org/10.1007/s11999-015-4605-2 CrossRefPubMed

Title: Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre
Authors: Sami A. Saku
Rami Madanat
Tatu J. Mäkinen
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3676-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Total knee arthroplasty in patients with a history of illicit intravenous drug abuse

Femoro-acetabular impingement: anatomic study of reliability and accuracy of alpha angle and offset ratio on fifty consecutive peri-operatively resected femoral heads

Percutaneous minimally invasive Akin osteotomy in hallux valgus interphalangeus: a case series

The influence of gender on early adverse events, hospital charges and length of stay after shoulder arthroplasty

Septic arthritis associated with systemic sepsis

Prolonged pre-operative hospital stay as a predictive factor for early outcomes and mortality after geriatric hip fracture surgery: a single institution open prospective cohort study