Predictors and Cost of Readmission in Total Knee Arthroplasty

Overview

Journal J Arthroplasty

Specialty Orthopedics

Date 2018 May 14

PMID 29753618

Citations 25

Authors

Kenneth L Urish

Yongmei Qin

Benjamin Y Li

Tudor Borza

Michael Sessine

Peter Kirk

Brent K Hollenbeck

Jonathan E Helm

Mariel S Lavieri

Ted A Skolarus

Bruce L Jacobs

Affiliations

Soon will be listed here.

Abstract

Background: The Comprehensive Care for Joint Replacement bundle was created to decrease total knee arthroplasty (TKA) cost. To help accomplish this, there is a focus on reducing TKA readmissions. However, there is a lack of national representative sample of all-payer hospital admissions to direct strategy, identify risk factors for readmission, and understand actual readmission cost.

Methods: We used the Nationwide Readmission Database to examine national readmission rates, predictors of readmission, and associated readmission costs for elective TKA procedures. We fit a multivariable logistic regression model to examine factors associated with readmission. Then, we determined mean readmission costs and calculated the readmission cost when distributed across the entire TKA population.

Results: We identified 224,465 patients having TKA across all states participating in the Nationwide Readmission Database. The mean unadjusted 30-day TKA readmission rate was 4%. The greatest predictors of readmission were congestive heart failure (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.62-2.80), renal disease (OR 2.19, 95% CI 2.03-2.37), and length of stay greater than 4 days (OR 2.4, 95% CI 2.25-2.61). The overall median cost for each readmission was $6753 ± 175. Extrapolating the readmission cost for the entire TKA population resulted in the readmission cost being 2% of the overall 30-day procedure cost.

Conclusions: A major focus of the Comprehensive Care for Joint Replacement bundle is improving cost and quality by limiting readmission rates. TKA readmissions are low and comprise a small percentage of total TKA cost, suggesting that they may not be the optimal measure of quality care or a significant driver of overall cost.

Citing Articles

Comparing prediction accuracy for 30-day readmission following primary total knee arthroplasty: the ACS-NSQIP risk calculator versus a novel artificial neural network model.

Buddhiraju A, Shimizu M, Chen T, Seo H, Bacevich B, Xiao P Knee Surg Relat Res. 2025; 37(1):3.

PMID: 39806502 PMC: 11727824. DOI: 10.1186/s43019-024-00256-z.

Revision total elbow arthroplasty is associated with a high rate of 30-day complications: A descriptive analysis of a national database.

El-Najjar D, Mehta A, Gupta P, Peterson J, Marigi E, Rogalski B Shoulder Elbow. 2024; :17585732241269001.

PMID: 39552697 PMC: 11562222. DOI: 10.1177/17585732241269001.

Early Readmission and Revision After Total Joint Arthroplasty: An Analysis of Cause and Cost.

Bido J, Torres R, Kaidi A, Rodriguez S, Rodriguez J HSS J. 2024; 20(2):187-194.

PMID: 39281996 PMC: 11393636. DOI: 10.1177/15563316241230052.

Readmission rate and early complications in patients undergoing total knee arthroplasty: A retrospective study.

Jethi T, Jain D, Garg R, Selhi H World J Orthop. 2024; 15(8):713-721.

PMID: 39165878 PMC: 11331325. DOI: 10.5312/wjo.v15.i8.713.

Enhancing recovery and reducing readmissions: The impact of remote monitoring on acute postoperative care in outpatient total joint arthroplasty.

DeRogatis M, Pellegrino A, Wang N, Higgins M, Dubin J, Issack P J Orthop. 2024; 58:111-116.

PMID: 39114426 PMC: 11301234. DOI: 10.1016/j.jor.2024.06.028.

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