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Characterization of Re-admission and Emergency Department Visits Within 90 Days Following Lower-Extremity Arthroplasty

  • Original Article
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HSS Journal ®

Abstract

Background

Acute care events including emergency department (ED) visits and unscheduled inpatient re-admissions following lower-extremity arthroplasty are not fully understood.

Question/Purposes

The purpose of this study was to characterize acute care events occurring after discharge in patients who received a lower-extremity arthroplasty: the incidence, timing, and risk factors of inpatient admission and ED visits within 90 days of discharge.

Methods

The New York State Inpatient and Emergency Department Databases were used to identify patients who underwent elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2009 to 2013 (124,234 and 76,411 patients, respectively). Multivariate logistic regression analysis was used to determine the predictors of and the most frequent reasons for unscheduled acute care within 90 days of discharge.

Results

Unscheduled acute care was needed in 13.79% of patients (8.81% of inpatient re-admissions and 4.98% of ED visits), most often in the first week after discharge (61.05% of all inpatient re-admissions and 20.46% of all ED visits). Most of these visits were for musculoskeletal pain, peri-prosthetic joint or wound infection, cardiac complications, blood transfusion, psychiatric events, mechanical complications, and deep vein thrombosis. Predictors for the need for acute care after TKA included African American and Hispanic race or ethnicity, Medicaid coverage, and neuraxial anesthesia. Predictors for the need for acute care after THA included older age (over 85 years), African American race, and Medicaid coverage.

Conclusion

We identified demographic and procedure-related variables associated with an increased risk of ED visits and inpatient re-admissions after TKA or THA. Understanding these variables will contribute to improved care quality.

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Acknowledgements

The authors thank Kara Fields and Yu-fen Chiu for their help with manuscript preparation.

Funding

This study was partially funded by the generous donations of Mr. Glenn Bergenfield, the Sidney Milton and Leoma Simon Foundation, and Mr. and Mrs. David Forber.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Elina Huerfano MD, Alejandro Gonzalez Della Valle MD, Kate Shanaghan & Federico Girardi

  2. Department of Anesthesia, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Stavros Memtsoudis MD & Jiabin Liu MD

Authors
  1. Elina Huerfano MD
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  2. Alejandro Gonzalez Della Valle MD
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  3. Kate Shanaghan
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  4. Federico Girardi
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  5. Stavros Memtsoudis MD
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  6. Jiabin Liu MD
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Corresponding author

Correspondence to Alejandro Gonzalez Della Valle MD.

Ethics declarations

Conflict of Interest

Elina Huerfano, MD, Kate Shanaghan, Federico Girardi, Stavros Memtsoudis, MD, and Jiabin Liu, MD, declare that they have no conflicts of interest. Alejandro Gonzalez Della Valle, MD, reports receiving personal fees from OrthoSensor, Ortho Development, LINK, and Intellijoint, outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level III: retrospective cohort study

Electronic Supplementary Material

Online Resource Fig. 1

Forest plot of musculoskeletal pain in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 45 kb)

Online Resource Fig. 2

Forest plot of periprosthetic infection/wound infection in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 39 kb)

Online Resource Fig. 3

Forest plot of cardiac complications excluding acute myocardial infarction in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 39 kb)

Online Resource Fig. 4

Forest plot of blood transfusions in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 47 kb)

Online Resource Fig. 5

Forest plot of psychiatric events in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 36 kb)

Online Resource Fig. 6

Forest plot of deep vein thrombosis in total knee arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 30 kb)

Online Resource Fig. 7

Forest plot of periprosthetic infection / wound infection in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 38 kb)

Online Resource Fig. 8

Forest plot of blood transfusions in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 48 kb)

Online Resource Fig. 9

Forest plot of cardiac complications excluding acute myocardial infarction in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 44 kb)

Online Resource Fig. 10

Forest plot of psychiatric events in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 29 kb)

Online Resource Fig. 11

Forest plot of mechanical complications in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 43 kb)

Online Resource Fig. 12

Forest plot of musculoskeletal pain in total hip arthroplasty cohort. Online Resource for “Characterization of Readmission and Emergency Department Visits Within 90 days Following Lower-Extremity Arthroplasty” (PNG 35 kb)

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Huerfano, E., Gonzalez Della Valle, A., Shanaghan, K. et al. Characterization of Re-admission and Emergency Department Visits Within 90 Days Following Lower-Extremity Arthroplasty. HSS Jrnl 14, 271–281 (2018). https://doi.org/10.1007/s11420-018-9622-8

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  • DOI: https://doi.org/10.1007/s11420-018-9622-8

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