Risk Factors for Readmissions After Total Joint Replacement: A Meta-Analysis

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Biostatistics

Background:

• Readmission after total hip arthroplasty (THA) and total knee arthroplasty (TKA) poses a significant challenge in healthcare.
• Predictive modeling is essential for identifying patients at high risk of readmission.
• Synthesizing existing evidence on risk factors is crucial for improving patient outcomes.

Purpose of the Study:

• To systematically review and meta-analyze predictive modeling studies on THA and TKA readmission risk.
• To identify and quantify key risk factors associated with post-arthroplasty readmissions.
• To evaluate the quality of existing predictive models and reporting standards.

Main Methods:

• Systematic review and meta-analysis of published literature.
• Qualitative review of 15 studies and quantitative meta-analysis of 17 studies.
• Assessment of study quality using PRISMA and NOS criteria.

Main Results:

• Key risk factors identified include age, length of stay, readmission reduction policy, peripheral nerve block use, and procedure type.
• Significant predictors of readmission were discharge to a skilled nursing facility (61% higher risk), low/medium-volume hospital surgery (26% higher risk), and patient obesity (34% higher risk).
• Study quality and reporting adherence to PRISMA and NOS standards were often suboptimal.

Conclusions:

• Discharge destination, hospital procedure volume, and patient obesity are significant, modifiable risk factors for readmission after THA/TKA.
• Clinical practice and future research should incorporate these identified risk factors into decision-making.
• Future predictive modeling studies must prioritize adherence to gold-standard reporting and methodological criteria.