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Published on: August 4, 2022
Risk Factors for Readmission Following Revision Total Hip Arthroplasty in Patients Undergoing Surgery for
Andrew S McGee1, John L Johnson2, Kyle D Paul2
1School of Medicine, University of Alabama at Birmimgham, Birmingham, USA.
Insights
Revision hip arthroplasty readmissions are common, costing billions. Obesity, hypertension, former smoking, and coronary artery disease are key risk factors for readmission after revision total hip arthroplasty.
Area of Science:
- Orthopedic Surgery
- Health Economics
Background:
- Readmission after revision orthopedic surgery incurs significant costs due to longer hospital stays and complex procedures.
- Approximately 20% of patients undergoing revision total hip arthroplasty (THA) face postoperative readmission.
- Annual readmissions cost the US federal government an estimated $17.4 billion.
Purpose of the Study:
- To identify risk factors associated with unplanned readmissions following revision total hip arthroplasty.
Main Methods:
- A retrospective case series review of patients undergoing revision THA between 2008 and 2018.
- Exclusions included outside hospital revisions, staged revisions, revisions for infection, and bilateral revisions.
- Data were collected via manual chart review, tracking readmissions from discharge to final follow-up.
Main Results:
- Out of 61 patients and 85 revision THAs analyzed, 19 patients (31.1%) were readmitted.
- Readmitted patients showed higher rates of coronary artery disease (31.6% vs. 6.5%), obesity, former smoking, and hypertension.
- The mean follow-up duration was significantly longer for readmitted patients (26.5 months) compared to non-readmitted patients (8.96 months).
Conclusions:
- Obesity, former tobacco use, younger age, coronary artery disease (CAD), and hypertension are associated with readmission after revision THA.
- Preoperative medical optimization of patients with these identified risk factors may substantially reduce healthcare costs associated with revision THA.
Abstract:
Introduction Readmission following revision orthopedic surgery imposes tremendous costs due to the increased length of stay, procedure complexity, and revision surgery. Following revision total hip arthroplasty, as many as one in five patients are readmitted postoperatively. Readmissions cost the federal government $17.4 billion annually. The purpose of this study was to identify risk factors for unplanned readmission following revision total hip arthroplasty. Methods This was a retrospective case series review of randomized revision total hip arthroplasties (THA) patients between 2008 and 2018. Exclusions were as follows: outside hospital revisions, staged revisions, revisions for infection, and bilateral revisions. Data were collected by manual chart review. Readmissions were tracked from discharge until the final follow-up. Results A total of 61 patients and 85 revision THAs were analyzed. Nineteen patients (31.1%) were readmitted; 31.6% of the readmitted patients had a coronary artery disease compared to 6.5% of non-readmitted patients. Readmission was also associated with obesity, former smokers, and hypertension. Also, the mean duration of follow-up was 26.5 months for readmitted patients as compared to 8.96 for non-readmitted patients. Conclusion Obesity, former tobacco use, younger age, coronary artery disease (CAD), and hypertension were associated with readmission. The medical optimization of patients with these risk factors prior to surgery could significantly lower costs relative to revision THA.
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