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. 2016 Oct;24(10):3329-3338.
doi: 10.1007/s00167-015-3782-6. Epub 2015 Sep 19.

Predictors of hospital readmission following revision total knee arthroplasty

Philip J Belmont Jr  1 , Gens P Goodman  2 , Marina Rodriguez  1 , Julia O Bader  3 , Brian R Waterman  1 , Andrew J Schoenfeld  4
Affiliations

Predictors of hospital readmission following revision total knee arthroplasty

Philip J Belmont Jr et al. Knee Surg Sports Traumatol Arthrosc. 2016 Oct.

Abstract

Purpose: Hospital readmission is emerging as an important quality measure, yet modifiable predictors of readmission remain unknown. This study was designed to identify risk factors for readmission following revision total knee arthroplasty.

Methods: The National Surgical Quality Improvement Program dataset was queried to identify patients undergoing revision total knee arthroplasty from 2011 to 2012. Patient demographics, medical co-morbidities, laboratory values, surgical characteristics and surgical outcomes were examined using bivariate and multivariate logistic regression to identify significant predictors for readmission within 30 days of discharge.

Results: There were 108 readmissions (6.2 %) among 1754 patients. Risk factors for readmission included a history of transient ischaemic attack/cerebrovascular accident (OR 3.47; 13 95 % CI 1.30, 9.25), female sex (OR 1.75, 95 % CI 1.15, 2.68) and general anaesthesia (OR 14 1.74, 95 % CI 1.09, 2.79). Hypertension treated with medication (OR 0.61, 95 % CI 0.39, 0.96) was associated with a lower risk of readmission. Post-operative complications that were significant predictors of hospital readmission included periprosthetic joint infection (OR 15.09, 95 % CI 5.57, 40.91), superficial wound infection (OR 16.57, 95 % CI 5.82, 47.22) and deep venous thrombosis (OR 8.59, 95 % CI 2.36, 31.24).

Conclusions: The preferred use of neuraxial anaesthesia and coordinated discharge planning in patients with a history of transient ischaemic attack/cerebrovascular accident may reduce the risk of readmission following discharge after revision total knee arthroplasty. Additionally, patients with post-operative infections and deep venous thrombosis following these procedures can benefit from close observation in the first weeks following discharge to minimize the likelihood of readmission.

Level of evidence: III.

Keywords: Complications; Hospital readmission; NSQIP; Revision total knee arthroplasty.

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