TKA Short-Stay Patients, Higher Readmission Rates. New Study

Surgeons in the UK set out to tease out reasons for readmission after total knee arthroplasty (TKA). Their study, “Predictors of 30-Day Readmission After Total Knee Arthroplasty: Analysis of 566,323 Procedures in the United Kingdom,” appears in the February 2019 edition of The Journal of Arthroplasty.

Alex Bottle, Ph.D. with the Faculty of Medicine at the School of Public Health at Imperial College London and co-author explained the genesis of this study to OTW. “This study arose in part from our realization that, although the 30-day all-cause readmission measure is the one that everyone uses and is the one in pay-for-performance schemes such as in the U.S., many readmissions are for reasons not directly connected to their arthroplasty.”

“We wanted to look at two alternative readmission measures. This study is part of a wider project looking at which are the best measures for surgeon and hospital performance; we compared the statistical properties of these three readmission measures in another recent paper in the same journal (ref #14), which recommended that surgeons, hospitals and regulators monitor ‘surgical readmissions’ alongside all-cause ones.”

The authors wrote, “All primary TKAs recorded in England’s National Health Service administrative database from 2006 to 2015 were included. In total, 566,323 procedures were recorded…”

Dr. Bottle told OTW, “The main result was that predictors of all-cause, surgical, and return to surgical theatre readmission often differed, particularly for return to theatre. We also note that short-stay patients had significantly higher readmission rates than those staying two nights. This is of interest due to the trend towards performing more arthroplasties with same-day discharge. It’s not clear how many and which patients this will be best for.”

“We identified several patient factors such as mental health conditions and neurological conditions that are associated with higher risk; patellofemoral replacements were associated with higher risk of return to theatre (reoperation) readmissions but lower risk of all-cause or surgical readmissions. These findings could help surgeons and their patients with the clinical decision-making process.”