Background

While risk factors have been published for readmissions following primary total joint arthroplasty, little is known about the etiology of those costly adverse events. In this study, we sought to identify the reasons for 30-day readmission following primary total joint arthroplasty in a contemporary national patient sample.

Methods

The American College of Surgeons National Surgical Quality Improvement Program was queried to identify 367,199 patients who underwent primary total knee (TKA) or hip arthroplasty (THA) between 2011 and 2018. The primary outcomes were the annual rates of 30-day readmissions and the causes of those readmissions.

Results

The 30-day readmission rate trended downward from 4.5% in 2011 to 3.3% in 2018. Medical complications accounted for 52.6% and 38.5% of readmissions following TKA and THA, respectively. Diseases of the circulatory system, abnormal laboratory values, and diseases of the digestive system were the leading causes of medical readmissions. Surgical complications accounted for 37.7% and 50.7% of readmissions following TKA and THA, respectively. Surgical site infections/wound disruption and venous thromboembolism were the leading two causes of surgical readmissions for THA and TKA. Prosthetic complications—namely dislocations and periprosthetic fractures—were the third leading cause of surgical readmissions for THA. For TKA, musculoskeletal conditions—namely pain and hematoma—were the third leading cause of surgical readmissions.

Conclusion

Medical complications accounted for half of all TKA readmissions and more than a third of THA readmissions. This could penalize institutions participating in value-based payment programs or dissuade others who are considering participation in such programs.

中文翻译：

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全关节置换术后再入院率：最新分析及其对基于价值的护理的启示

背景

虽然已经公布了初次全关节置换术后再入院的风险因素，但对这些代价高昂的不良事件的病因知之甚少。在这项研究中，我们试图找出当代全国患者样本中初次全关节置换术后 30 天再入院的原因。

方法

美国外科医师学会国家外科质量改进计划被查询以确定 367,199 名在 2011 年至 2018 年间接受初次全膝关节 (TKA) 或髋关节置换术 (THA) 的患者。主要结果是 30 天再入院的年率和原因那些再入院。

结果

30 天再入院率从 2011 年的 4.5% 下降到 2018 年的 3.3%。医疗并发症分别占 TKA 和 THA 后再入院的 52.6% 和 38.5%。循环系统疾病、化验值异常和消化系统疾病是再入院的主要原因。手术并发症分别占 TKA 和 THA 后再入院的 37.7% 和 50.7%。手术部位感染/伤口破裂和静脉血栓栓塞是 THA 和 TKA 手术再入院的两个主要原因。假体并发症——即脱位和假体周围骨折——是 THA 手术再入院的第三大主要原因。对于 TKA，肌肉骨骼疾病（即疼痛和血肿）是手术再入院的第三大主要原因。

结论

医疗并发症占所有 TKA 再入院的一半和 THA 再入院的三分之一以上。这可能会惩罚参与基于价值的支付计划的机构或劝阻其他正在考虑参与此类计划的机构。