Hospital-Acquired Conditions Can Significantly Impact TJA Readmissions

Hospital-acquired conditions can significantly impact 30-day hospital readmission following primary knee and hip arthroplasty, accounting for as many as 42 percent of complications found during a five-year period, study results indicate.

Researchers from Missouri and Alabama retrospectively analyzed data from the Surgical Care Improvement Project and the Veteran’s Affairs Surgical Quality Improvement Program (VASQIP) to identify16,808 partial and total knee and 9,902 partial and total hip arthroplasties performed from 2005 to 2009. Hospital-acquired conditions (HACs), such as venous thromboembolism, pneumonia, surgical site infections and urinary tract infections, were the independent variables of interest, with the dependent variable being hospital readmission within 30 days of discharge.

Predictors for early readmission collected from VASQIP data included patient demographics, lifestyle variables, and pulmonary, cardiovascular, hepatobiliary, renal, immune and nutritional comorbidities. In addition, researchers analyzed arthroplasty type, the indication for surgery, wound classification, American Society of Anesthesiologist status and duration of surgery. Multivariate regression analysis was used to determine predictors of 30-day readmission.

Findings showed 12.4 percent of patients were more likely to be readmitted after having developed at least one postoperative complication compared with patients without complications. Of the 3,371 total complications observed in 1,405 patients, 41.7 percent were HACs. Overall, 1,901 patients had 2,082 non-HAC complications.

Investigators found 53 percent of HACs were observed prior to discharge, and 47 percent of HACs developed after patients were discharged. Most patients were discharged home then either discharged to a skilled nursing facility, immediate care or rehabilitation facility. Patients frequently were readmitted when they left the hospital against medical advice. Overall, 5.7 percent of patients were readmitted after being discharged home.