Are Readmissions After THA Preventable?

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Quality Improvement

Background:

• Hospital readmissions after total joint arthroplasty (THA) are a key quality metric in the US.
• The Hospital Readmission Reduction Program penalizes hospitals with high readmission rates, but their effectiveness as a quality metric is debated.
• While causes of THA readmissions are known, the extent of their preventability remains unclear.

Purpose of the Study:

• To determine if unplanned readmissions after THA are due to orthopaedic or medical causes.
• To assess the preventability of these readmissions.
• To identify the timing of orthopaedic versus medical readmissions during the postoperative period.

Main Methods:

• Retrospective evaluation of 1096 elective THAs for osteoarthritis.
• Analysis of 69 patients (6%) readmitted within 90 days (50 within 30 days).
• Physician panel reviewed cases using consensus guidelines to classify readmissions as orthopaedic vs. medical and preventable vs. non-preventable.

Main Results:

• Of 69 readmissions, 45% were for orthopaedic reasons and 55% for medical reasons.
• Only 4% (3 of 69) of readmissions were deemed potentially preventable (1 orthopaedic, 2 medical).
• Thirty-day readmissions were significantly more likely to be orthopaedic compared to 90-day readmissions (OR 4.06).

Conclusions:

• A small proportion of THA readmissions appear to be potentially preventable.
• Orthopaedic readmissions tend to occur earlier postoperatively than medical readmissions.
• Current readmission policies and penalties may not be optimal external quality metrics for THA, necessitating further refinement of criteria for preventable readmissions.