Highlights
- •Compared to 2009, overall rates of 30-day readmissions after total hip replacement (THR) decreased by 1.3% in 2014. The decrease in readmission rates varied by groups, with lesser improvements seen in THR patients who were younger, with private insurance, and residing in lower-income and rural communities.
- •Among all groups, only THR patients aged 18 to 44 years showed an increase (0.5%) in 30-day hospital readmission rates.
- •Device complications were the leading cause of readmission in THR patients, increasing from 19.8% in 2009 to 23.9% in 2014.
Abstract
Objective
To document changes in 30-day hospital readmission rates and causes for returning
to the hospital for care in THR patients.
Design
Retrospective cross-sectional descriptive design.
Setting
Community-based acute care hospitals.
Participants
Total sample size (N=142,022) included THR patients (identified as ICD-9-CM procedure
code 81.51) in 2009 (n=31,232) and (n=32,863) in 2014.
Interventions
Not applicable.
Main Outcome Measures
30-Day hospital readmission.
Results
The overall readmission rate decreased by 1.3% from 2009 to 2014. The decrease in
readmission rates varied by groups, with lesser improvements seen in THR patients
who were younger, with private insurance, and residing in lower-income and rural communities.
Device complications were the leading cause of readmission in THR patients, increasing
from 19.8% in 2009 to 23.9% in 2014.
Conclusions
There has been little decrease in hospital 30-day readmission rates for US community
hospitals between 2009 and 2014. Findings from this brief report indicate patient
groups at greater risk for 30-day hospital readmission as well as leading causes for
readmission in THR patients which can inform the development of tailored interventions
for reduction.
Keywords
List of abbreviations:
HCUP (Healthcare Cost and Utilization Project), HRRP (Hospital Readmissions Reduction Program), NRD (Nationwide Readmissions Database)To read this article in full you will need to make a payment
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References
- Changes in payment regulation and acute care use for total hip replacement: trends in length of stay, costs, and discharge, 1997-2012.Rehabil Nurs. 2016; 41: 67-77
- Patient, surgery, and hospital related risk factors for surgical site infections following total hip arthroplasty.ScientificWorldJournal. 2015; 2015: 979560
- Health Policy Brief: Medicare Hospital Readmissions Reduction Program. To improve care and lower costs, Medicare imposes a financial penalty on hospitals with excess readmissions.Project HOPE, Bethesda2013 (Available at:) (Accessed December 2, 2017)
- Readmissions Reduction Program (HRRP).(Available at:) (Accessed December 2, 2017)
- Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008.JAMA. 2011; 305: 1560-1567
- Racial disparities in knee and hip total joint arthroplasty: an 18-year analysis of national Medicare data.Ann Rheum Dis. 2014; 73: 2107-2115
- Hospital readmission rates falling among older adults receiving joint replacements.AARP Public Policy Institute, Washington (DC)2015 (Available at:) (Accessed November 4, 2017)
- Trends in utilization and outcomes of hip arthroscopy in the United States between 2005 and 2013.J Arthroplasty. 2017; 32: 750-755
- The influence of obesity on primary total hip arthroplasty outcomes: a meta-analysis of prospective cohort studies.Orthop Traumatol Surg Res. 2015; 101: 289-296
- Understanding racial and ethnic disparities in postsurgical complications occurring in U.S. hospitals.Health Serv Res. 2017; 52: 220-243
- Revisions of monoblock metal-on-metal THAs have high early complication rates.Clin Orthop Relat Res. 2015; 473: 469-474
- Do complication rates differ by gender after metal-on-metal hip resurfacing arthroplasty? A systematic review.Clin Orthop Relat Res. 2015; 473: 2521-2529
- Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample.Anesthesiology. 2010; 112: 917-925
- Severe sepsis and septic shock in the elderly: an overview.World J Crit Care Med. 2012; 1: 23-30
- Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies.PLoS One. 2015; 10: e0125827
- Patient characteristics and differences in hospital readmission rates.JAMA Intern Med. 2015; 175: 1803-1812
- Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study.Ann Intern Med. 2014; 161: 765-774
- The contribution of skilled nursing facilities to hospitals' readmission rate.Health Serv Res. 2017; 52: 656-675
Article info
Publication history
Published online: February 04, 2018
Footnotes
Supported by the National Center for Advancing Translational Sciences at the National Institutes of Health (grant no. UL1TR001117). Also supported in part by the National Institute on Aging (grant nos. 2P30AG028716-06 and K24 AG049077-01A1) and in part by the National Institute on Minority Health and Health Disparities (grant no. 5R01MD010354-02).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
