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Who Cares for Total Hip Arthroplasty Complications? Rates of Readmission to a Hospital Different From the Location of the Index Procedure

Chen, James B. MD; Hegde, Vishal MD; Cheung, Edward C. MD; Stavrakis, Alexandra I. MD; SooHoo, Nelson F. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 15, 2019 - Volume 27 - Issue 14 - p e669–e675
doi: 10.5435/JAAOS-D-18-00464
Research Article

Introduction: While the number of total hip arthroplasties (THAs) performed increases, so is the number of postoperative readmissions, resulting in costly episodes of care that may disproportionately affect certain hospitals. This study examines the rates of readmission of patients to the same hospital at which they underwent index THA, compared with readmission to a different hospital.

Methods: Data for all hospital discharges from 1995 to 2010 were obtained from the California Office of Statewide Health Planning and Development database. Patient outcomes, readmission data, demographic information, hospital teaching status, and location were analyzed. Regression modeling was used to evaluate the effect of hospital teaching status, location, and individual complications on the risk of readmission to the same hospital as opposed to a different hospital following the index procedure.

Results: The overall postoperative readmission rate for specific defined complications or all-cause 30-day readmissions was 3.92%, with 75.17% readmitted to the same hospital. Following index THA at a nonacademic or academic hospital, 95.9% and 84.6% of patients were readmitted to the same type of hospital, respectively. Patients who had their index procedure at an academic hospital had lower odds for readmission to the same hospital (odds ratio, 0.734; P < 0.0001) compared with nonacademic centers. Hospitals in midsize towns had higher odds of readmission to the same hospital (odds ratio, 1.735; P = 0.0012) compared with those in large metropolitan areas.

Discussion: Although more than 75% of patients with unplanned readmissions went to the same hospital as their index THA, academic and larger metropolitan hospitals had higher odds of postoperative readmissions to a different hospital.

From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Correspondence to Dr. Chen:

Dr. SooHoo or an immediate family member serves as a board member, owner, officer, or committee member of American Orthopaedic Foot and Ankle Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Chen, Dr. Hegde, Dr. Cheung, and Dr. Stavrakis.

© 2019 by American Academy of Orthopaedic Surgeons
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