Predictors of 30-day readmission after total knee arthroplasty: analysis of 566,323 procedures in the United Kingdom
File(s)
Author(s)
Ali, Adam M
Loeffler, Mark D
Aylin, Paul
Bottle, Alex
Type
Journal Article
Abstract
BACKGROUND: All-cause 30-day readmission after total knee arthroplasty (TKA) is currently used as a measure of hospital performance in the United States and elsewhere. Readmissions from surgical causes may more accurately reflect preventability and costs. However, little is known about whether predictors of each type of readmission differ. METHODS: All primary TKAs recorded in England's National Health Service administrative database from 2006 to 2015 were included. Multilevel logistic regression analysis was used to describe the effects of patient-related factors on 30-day readmission risk using 3 different readmission metrics: all-cause, surgical (defined using International Classification of Disease-10 primary admission diagnoses), and those resulting in return to theater (RTT). RESULTS: In total, 566,323 procedures were recorded. The comorbidity with the highest odds ratio (OR) for all types of readmission was psychoses (RTT OR 2.52, P < .001). Obesity was a strong independent predictor of RTT (OR 1.36, P < .001) and had the highest population attributable fraction of any comorbidity (4.7%). Unicompartmental arthroplasty was associated with a significantly lower risk of all types of readmission when compared with TKA, with the effect being most pronounced for surgical readmission (OR 0.66, P < .001). RTT in the index episode increased the risk of RTT readmission (OR 2.80, P < .001), as did any emergency admission to hospital in the preceding 12 months (for >2 emergency admissions, all-cause OR 2.38, P < .001). Length of stay either more than or less than 2 days was associated with an increased risk of all-cause and surgical readmission but not RTT readmission. CONCLUSION: Patient-related predictors of surgical and RTT readmission following TKA differ from those for all-cause readmission, but only the latter metric is in widespread use.
Date Issued
2019-02-01
Date Acceptance
2018-10-23
Citation
Journal of Arthroplasty, 2019, 34 (2), pp.242-248.e1
ISSN
0883-5403
Publisher
Elsevier
Start Page
242
End Page
248.e1
Journal / Book Title
Journal of Arthroplasty
Volume
34
Issue
2
Copyright Statement
© 2018 Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor
National Institute for Health Research
Dr Foster Intelligence
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30477965
PII: S0883-5403(18)31083-0
Grant Number
n/a
WPPA_P72388
Subjects
emergency readmission
readmission
return to theater
total knee arthroplasty
total knee replacement
unicompartmental knee replacement
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2018-11-02