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Several hospital, clinical factors attributed to readmission after TKA
To reduce the variation in hospital readmissions after total knee arthroplasty, further optimization of anti-infection measures — both intraoperative and postoperative — are needed, according to recently published results.
Researchers used the Medicare 100% national hospitals claims database to identify 952,593 patients aged 65 years and older who underwent primary total knee arthroplasty (TKA) in 3,848 hospitals between 2010 and 2013. Using a multilevel logistic regression analysis with a clustered data structure, researchers investigated the risk of all-cause 30-day and 90-day readmission, incorporating hospital, clinical and patient factors.
Results showed readmission ranged from 0% to 22% at 30 days postoperatively and from 0% to 32% at 90 days postoperatively. Researchers found significant hospital factors for readmission included geographic census region, hospital procedure volume, rural hospital location and nonprofit ownership. According to results, use of a perioperative transfusion was associated with 13% greater risk of readmission. Investigators also found patients discharged home had a 25% lower risk of readmission. Researchers also noted a significant association of surgeon volume and length of stay with readmission.
Results showed the effect sizes were at least comparable to patient factors, including age, gender, comorbidities and socioeconomic status. Wound infection, deep infection, atrial fibrillation, cellulitis and abscess of leg, or pulmonary embolism were the top five most reported primary reasons for 30-day and 90-day readmissions in patients who underwent TKA, according to results. – by Casey Tingle
Disclosures: Kurtz reports he is an employee and shareholder for Exponent, which receives fees for providing consulting services to other medical device companies; receives research support from Smith & Nephew, Stryker, Zimmer Biomet, DePuy Synthes, Medtronic, Invibio, Stelkast, Formae, Kyocera Medical, Wright Medical Technology, CeramTec, DJO, Celanese, Aesculap, Simplify Medical, Active Implants and Ferring Pharmaceuticals; and receives royalties, financial or material support from Elsevier. Please see the full study for a list of all other authors’ relevant financial disclosures.