Are Readmissions After Total Knee Arthroplasty Preventable?

Abstract

Readmission within 90 days following total joint arthroplasty has become a central quality measure of reimbursement initiatives; however, the validity of readmission rates as a measure of hospital care quality and the proportion of readmissions that are preventable are unknown. The purpose of this study is to determine if readmissions within 30 and 90 days after total knee arthroplasty (TKA) were related to orthopaedic or medical etiology and identify if these readmissions were preventable. We retrospectively reviewed 1,625 elective TKAs performed between 2011 and 2014 at our institution. Readmissions within 30 and 90 days were categorized into orthopaedic and medical etiologies and an expert research panel determined if readmissions were potentially preventable based on objective criteria from national or peer-reviewed consensus guidelines. Out of the 1,625 TKAs performed during the study period, there were a total of 79 (4.8%) readmissions within 90 days of surgery, of which 17 (22%) were of orthopaedic etiology and 62 (78%) were of medical etiology. Fifty-two (66%) of the 79 readmissions occurred within 30 days, with 11 (21%) of orthopaedic and 41 (80%) of medical etiology. Only 2 of 79 (3%) readmissions within 90 days were deemed potentially preventable, and neither of them were orthopaedic in nature. Hospital readmissions after total joint arthroplasty are inevitable; however, only a small percentage (3%) of readmissions to our health care system was potentially preventable. Orthopaedic readmissions constituted a minority of the proportion of readmissions at 30 or 90 days, and none were deemed preventable.