Factors Associated With 30-Day Readmission After Primary Total Hip Arthroplasty: Analysis of 514?455 Procedures in the UK National Health Service.

ABSTRACT:

Importance

Thirty-day readmission to hospital after total hip arthroplasty (THA) has significant direct costs and is used as a marker of hospital performance. All-cause readmission is the only metric in current use, and risk factors for surgical readmission and those resulting in return to theater (RTT) are poorly understood.

Objective

To determine whether patient-related predictors of all-cause, surgical, and RTT readmission after THA differ and which predictors are most significant.

Design, setting, and participants

Analysis of all primary THAs recorded in the National Health Service (NHS) Hospital Episode Statistics database from 2006 to 2015. The effect of patient-related factors on 30-day readmission risk was evaluated by multilevel logistic regression analysis. The analysis comprised all acute NHS hospitals in England and all patients receiving primary THA.

Main outcomes and measures

Thirty-day readmission rate for all-cause, surgical (defined using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision primary admission diagnoses), and readmissions resulting in RTT.

Results

Across all hospitals, 514?455 procedures were recorded. Seventy-nine percent of patients were older than 60 years, 40.3% were men, and 59.7% were women. There were 30?489 all-cause readmissions (5.9%), 16?499 surgical readmissions (3.2%), and 4286 RTT readmissions (0.8%); 54.1% of readmissions were for surgical causes. Comorbidities with the highest odds ratios (ORs) of RTT included those likely to affect patient behavior: drug abuse (OR, 2.22; 95% CI, 1.34-3.67; P?=?.002), psychoses (OR,?1.83; 95% CI, 1.16-2.87; P?=?.009), dementia (OR, 1.57; 95% CI, 1.11-2.22; P?=?.01), and depression (OR,?1.52; 95% CI, 1.31-1.76; P?2 emergency readmissions, OR, 2.33; 95% CI, 2.11-2.57; P?Conclusions and relevanceMany patient-related risk factors for surgical and RTT readmission differ from those for all-cause readmission despite the latter being the only measure in widespread use. Clinicians and policy makers should consider these alternative readmission metrics in strategies for risk reduction and cost savings.

SUBMITTER: Ali AM 

PROVIDER: S-EPMC5831438 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature