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Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital.
J Arthroplasty. 2017 06; 32(6):1739-1746.JA

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Authors+Show Affiliations

Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina.Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.Department of Orthopaedics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28153458

Citation

Varacallo, Matthew A., et al. "Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital." The Journal of Arthroplasty, vol. 32, no. 6, 2017, pp. 1739-1746.
Varacallo MA, Herzog L, Toossi N, et al. Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital. J Arthroplasty. 2017;32(6):1739-1746.
Varacallo, M. A., Herzog, L., Toossi, N., & Johanson, N. A. (2017). Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital. The Journal of Arthroplasty, 32(6), 1739-1746. https://doi.org/10.1016/j.arth.2016.12.035
Varacallo MA, et al. Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital. J Arthroplasty. 2017;32(6):1739-1746. PubMed PMID: 28153458.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital. AU - Varacallo,Matthew A, AU - Herzog,Leah, AU - Toossi,Nader, AU - Johanson,Norman A, Y1 - 2016/12/27/ PY - 2016/07/23/received PY - 2016/12/11/revised PY - 2016/12/19/accepted PY - 2017/2/6/pubmed PY - 2018/1/20/medline PY - 2017/2/4/entrez KW - bundled payments KW - primary THA KW - primary TJA KW - primary TKA KW - readmission SP - 1739 EP - 1746 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 6 N2 - BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28153458/Ten_Year_Trends_and_Independent_Risk_Factors_for_Unplanned_Readmission_Following_Elective_Total_Joint_Arthroplasty_at_a_Large_Urban_Academic_Hospital_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(16)30920-2 DB - PRIME DP - Unbound Medicine ER -