Characterizing the Cost Trends of Readmissions After Aseptic Revision Total Knee Arthroplasty

A rise in total knee arthroplasty (TKA) volume has led to an increased incidence of aseptic revision TKA (rTKA), resulting in major associated health care costs. This study evaluated the economic impact and clinical factors associated with readmission following aseptic rTKA, aiming to identify key drivers of cost and risk factors for readmission.

This retrospective analysis used data from a large national database from January 1, 2009, to June 30, 2022. Patients undergoing aseptic rTKA were identified via Current Procedural Terminology codes. Readmissions within 90 days postoperatively were analyzed. Baseline characteristics, comorbidities, and readmission costs were compared, and significant risk factors for readmission were identified. Of 34,144 aseptic rTKA patients, 1,953 (5.7%) were readmitted within 90 days (56.1% medical, 29.2% surgical, and 14.8% unknown).

The median cost of all readmissions was $25,181. Readmissions requiring reoperation had a higher cost (median $40,524 versus $20,907, P < 0.001). Among readmissions for surgical complications, periprosthetic joint infection was the most common cause (36.3%) and was associated with the greatest cost (median $38,104). The most common medical causes of readmission were rehabilitative care, ischemic cardiac events, and acute kidney injury. Significant risk factors for all-cause readmission included men, index revision for periprosthetic fracture, and comorbidities, including diabetes, coronary artery disease, renal disease, and congestive heart failure.

Readmission after aseptic rTKA results in a major economic burden to the health care system, particularly in readmission pertaining to surgical complications and requiring reoperation. This study highlights the need for targeted strategies aimed at effectively reducing the rate and costs associated with readmission post-rTKA with a goal of cost containment and improved patient outcomes.