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Disparities in 30-Day Readmissions After Total Hip Arthroplasty

Oronce, Carlos Irwin A. MS*; Shao, Hui MHA; Shi, Lizheng PhD


In the article published on pages 924-930 of Medical Care’ s November 2015 issue, Table 1 includes some cells that are in violation of one provision from the Agency for Healthcare Research and Quality (AHRQ). The bolded cells below have been modified to fully comply with AHRQ guidelines.

Medical Care. 54(7):733, July 2016.

doi: 10.1097/MLR.0000000000000421
Original Articles

Background: Policymakers have expanded readmissions penalties to include elective total hip arthroplasties (THA), but little is known whether disparities exist on the basis of race, socioeconomic status, or payer.

Objective: To identify disparities in elective primary THA readmissions based on race, socioeconomic status, and type of insurance.

Research Design: This analysis is a retrospective cohort study of patients discharged for an elective THA. The Healthcare Cost & Utilization Project’s State Inpatient Database from California was used to identify index hospitalizations for elective primary THA and rehospitalizations within 30 days of discharge. We used multivariate logistic regression to examine differences in readmissions by race, socioeconomic status, and insurance.

Subjects: Subjects included patients discharged from California hospitals from 2009 through 2011 after THA.

Measures: Risk-adjusted odds of all-cause 30-day readmission.

Results: The overall rate of unplanned 30-day all-cause readmissions was 4.6%. African American [odds ratio (OR)=1.38; 95% confidence interval (CI), 1.16–1.64] and Hispanic (OR=1.16; 95% CI, 1.00–1.34) patients had a higher risk of readmission than white patients after THA, when accounting for comorbidities and hospital factors. The observed difference for Hispanic patients, however, was null after adjusting for socioeconomic status and payer. Lower socioeconomic status was associated with higher odds of readmission (OR=1.24; 95% CI, 1.10–1.39). Compared with private insurance, Medicare (OR=1.26; 95% CI, 1.13–1.43), Medicaid (OR=1.86; 95% CI, 1.49–2.32), and uninsured status (OR=1.31; 95% CI, 1.01–1.69) were also associated with increased readmission risk.

Conclusions: We found significant differences in the odds of 30-day readmissions on the basis of race, socioeconomic status, and payer. As readmissions penalties become widely adopted, payers need to be mindful of their effects on vulnerable populations.

Supplemental Digital Content is available in the text.

*Tulane University School of Medicine and School of Public Health & Tropical Medicine

Department of Global Health Systems and Development, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

The authors declare no conflict of interest.

Reprints: Carlos I.A. Oronce, MS, MD/MPH Candidate, Tulane University School of Medicine and School of Public Health & Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112. E-mail:

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