Elsevier

The Journal of Arthroplasty

Volume 29, Issue 8, August 2014, Pages 1532-1538
The Journal of Arthroplasty

Thirty-Day Readmission Following Total Hip and Knee Arthroplasty – A Preliminary Single Institution Predictive Model

https://doi.org/10.1016/j.arth.2014.02.030Get rights and content

Abstract

We sought to identify demographic or care process variables associated with increased 30-day readmission within the total hip and knee arthroplasty patient population. Using this information, we generated a model to predict 30-day readmission risk following total hip and knee arthroplasty procedures. Longer index length of stay, discharge disposition to a nursing facility, blood transfusion, general anesthesia, anemia, anticoagulation status prior to index admission, and Charlson Comorbidity Index greater than 2 were identified as independent risk factors for readmission. Care process factors during the hospital stay appear to have a large predictive value for 30-day readmission. Specific comorbidities and patient demographic factors showed less significance. The predictive nomogram constructed for primary total joint readmission had a bootstrap-corrected concordance statistic of 0.76.

Section snippets

Study Design

This study was a retrospective case–control comparison analysis, composed of orthopaedic admissions and readmissions, over a 12-month period (May 1, 2010 to April 30, 2011). Institutional Review Board approval was obtained.

Data Sources

Data for all orthopaedic inpatient encounters was obtained from a readmission database, which was implemented in April 2010. Primary total hip and knee arthroplasty patients (1,291 admissions/1,236 patients) were identified using DRG Codes 469 and 470. Exclusion criteria

Results

After exclusion criteria, 2,368 adult admissions to the orthopaedic service were identified during the one-year study period, including 159 (144 patients, 6.7%) unplanned readmission episodes – 117 of which were unique, unplanned patient readmissions in the general orthopaedic population. Concerning the 1,291 (1,236 patients) primary total hip and knee arthroplasty index admissions, 46 (44 patients, 3.6%) underwent early readmission within 30 days of index admission discharge. Of the total 159

Discussion

One high priority issue being addressed in the move toward value-based care is a relatively high incidence of early readmission following hospital discharge. To our knowledge, this is the first study to develop and define a predictive model for early readmission within the primary total joint population. At the inception of this study, we aimed to understand whether the data collected in our newly formed institutional readmission database could be utilized to create a pragmatic way toward

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  • Cited by (0)

    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.02.030.

    1

    (Graduated from program June 2013 – pursuing an orthopaedic oncology fellowship at Vanderbilt University this year).

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