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Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

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.

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Acknowledgments

We thank Vanessa Chan MPH, for her help in preparing the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA, 94143-0728, USA

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

Authors
  1. William W. Schairer MD
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  2. David C. Sing BS
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  3. Thomas P. Vail MD
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  4. Kevin J. Bozic MD, MBA
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Corresponding author

Correspondence to Kevin J. Bozic MD, MBA.

Additional information

One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of USD 10,000 from DePuy Orthopaedics, Inc (Warsaw, IN, USA). KJB received funding from Orthopaedic Research and Education Foundation which ended in 2009. Although the study period (2005-2011) included the years of his research funding. This study was completed after his OREF funding was completed. The institution of one or more of the authors (KJB) has received, during the study period, funding from the OREF (Rosemont, IL, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that institution where the work was performed approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Schairer, W.W., Sing, D.C., Vail, T.P. et al. Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty. Clin Orthop Relat Res 472, 464–470 (2014). https://doi.org/10.1007/s11999-013-3121-5

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  • DOI: https://doi.org/10.1007/s11999-013-3121-5

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