Incidence, Risk Factors, and Costs for Hospital Returns after Total Joint Replacements

• Published in: The Journal of arthroplasty
• Main Authors: Sibia, Udai S., MD MBA, Mandelblatt, Abigail E., BS, Callanan, Maura A., MS MBA, MacDonald, James H., MD, King, Paul J., MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Orthopedics; Costs; Unplanned emergency department visits; Total Joint Replacements; Risk factors; Readmissions
• ISSN: 0883-5403
• DOI: 10.1016/j.arth.2016.08.003

Abstract Background Unplanned hospital returns after total joint replacement (TJR) reduce any cost savings in a bundled reimbursement model. We examine the incidence, risk factors, and costs for unplanned Emergency Department (ED) visits and readmissions within 30 days of index TJR. Methods We retrospectively reviewed a consecutive series of 655 TJRs (382 TKR and 273 THR) performed between April 2014 and March 2015. Preoperative diagnosis was osteoarthritis of the hip or knee (97%) or avascular necrosis of the hip (3%). Hospital costs were recorded for each ED visit and readmission episode. Results Of the 655 TJRs reviewed, 55 (8.4%) returned to the hospital. Of these hospital returns, 35 patients (5.3%) returned for a total of 36 unplanned ED visits whereas the remaining 20 patients (3.1%) presented 22 readmissions within 30 days of index TJR. The two most common reasons for unplanned ED visits were postoperative pain/swelling (36%) and medication-related side-effects (22%). Avascular necrosis of the hip was a significant risk factor for an unplanned ED visit (7.27 OR, 95% CI 1.67-31.61, p =0.008). Multiple logistic regression analysis revealed the following risk factors for readmission: BMI (1.10 OR, 95% CI 1.02-1.78, p =0.013), comorbidity >2 (2.07 OR, 95% CI 1.06-6.95, p =0.037), and prior TKR (2.61 OR, 95% CI 1.01-6.72, p =0.047). Ambulating on the day of surgery trended towards a lower risk for readmission (0.13 OR, 95% CI 0.02-1.10, p =0.061). The two most common reasons for readmission were ileus (23%) and cellulitis (18%). The total cost associated with unplanned ED visits were $15,427 whereas costs of readmissions totaled $142,654. Conclusion Unplanned ED visits and readmissions in the forthcoming bundled payments reimbursement model will reduce cost savings from rapid recovery protocols for TJR. Identifying and mitigating preventable causes of unplanned visits and readmissions will be critical to improving care and controlling costs.