Clinical factors found more important than hospital factors in 30-day THA readmission rates

ORLANDO, Fla. — The wide variability in the geographic location of U.S. hospitals may be a factor that affects readmission rates. However, clinical factors more greatly influenced 30-day readmission rates for Medicare patients following total hip arthroplasty, according to study results presented here.

“This is a very hot topic and a lot of papers that are published discuss the patient and clinical factors, as well. We found that the top five were procedure-related. This supports further optimization – not just who you pick to perform the surgery, but also paying attention to how you deliver care,” Steven M. Kurtz, PhD, said at the American Academy of Orthopaedic Surgeons Annual Meeting.

Kurtz and colleagues studied the hospital and clinical factors that influenced the 30-day readmissions after primary total hip arthroplasty (THA). They used 100% Medicare national hospital claims to identify 442,333 patients aged 65 years or older who underwent THA at 3,730 hospitals in the United States between 2010 and 2013. The investigators used a 1-year look-up period prior to THA to study comorbidities, hospital volumes and surgeon volumes. Hospital factors included geographic location, bed size and hospital type. Clinical factors included length of stay, discharge status and perioperative transfusion.

They concluded there was a wide geographic variation in 30-day readmission among hospitals. Patients in the western part of the United States, for example, had a 9% to 14% lower readmission risk. Geography, hospital procedure volume and nonprofit ownership were the only significant hospital factors.

Clinical factors were more important than general hospital factors in 30-day readmission rates, Kurtz said. Perioperative transfusion was associated with a greater risk, while patients who were discharged home had a lower risk. Surgeon volume and length of stay were significant clinical factors, he noted. The top five reasons for readmission were procedure-related 30 days after THA. They included dislocation, deep infection, wound infection, periprosthetic fracture or hematoma. – by Kristine Houck, ELS

Reference:

Kurtz SM, et al. Paper #172. Presented at: American Academy of Orthopaedic Surgeon Annual Meeting; March 1-5, 2016; Orlando, Fla.

Disclosure: Kurtz reports he is an employee and shareholder of Exponent, a scientific and engineering consulting firm.