Hospital Exposure Prior to Total Hip Arthroplasty: Are Perioperative Outcomes Impacted?

Abstract

As demand for total hip arthroplasty (THA) continues to grow, identifying risk factors for poor perioperative outcomes may help guide preoperative planning. Therefore, the aim of the present study was to determine the risk of adverse outcomes following THA after a preoperative health care event (PHE). This was a single-institution retrospective review of all patients who underwent primary THA from September 2011 to April 2022. Patients were stratified based on whether they had a PHE or not. PHEs were defined as an emergency department visit or hospital admission within 90 days of surgery. Binary logistic regression was fit for discharge disposition, 30- and 90-day readmission, and 1 year revision while controlling for all significant covariates. We identified a total of 11,598 patients' status post-THA, of whom 273 had a PHE. PHE patients were significantly more likely to require facility discharge (odds ratio [OR]: 2.490; p < 0.001) than those who did not have a PHE. Additionally, any PHE predisposed patients to significantly higher 30-day (OR: 1.992; p = 0.013) and 90-day (OR: 2.387; p < 0.001) readmission rates. Patients with two or more PHEs were at an even greater risk of facility discharge (OR: 3.679; p = 0.001), readmission within 30 days (OR: 4.204; p = 0.009), and readmission within 90 days (OR: 7.965; p < 0.001). Patients who undergo THA after having a PHE are at significantly higher risk of facility discharge and readmission. A temporary recovery period and evaluation of surgical candidacy following a PHE and prior to THA may lead to better postoperative outcomes.

Level III Evidence Retrospective Cohort Study

Keywords

total hip arthroplasty - preoperative health care event - facility discharge - readmission - outcomes

Publication History

Received: 17 February 2023

Accepted: 23 August 2023

Article published online:
22 November 2023

• References

• 1 Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021. J Bone Joint Surg Am 2014; 96 (08) 624-630
• 2 Schwarzkopf R, Behery OA, Yu H, Suter LG, Li L, Horwitz LI. Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty. J Arthroplasty 2019; 34 (10) 2304-2307
• 3 Kiskaddon EM, Soehnlen NT, Erb E, Froehle AW, Green U, Krishnamurthy A. Preoperative emergency department visits are predictive of 90-day postoperative emergency department visits and discharge disposition in total knee arthroplasty patients. J Knee Surg 2022; 35 (06) 640-644
• 4 Johnson SP, Swiatek PR, Chung KC. Effect of posthospital syndrome on discharge disposition and healthcare utilization after primary total joint arthroplasty. J Arthroplasty 2020; 35 (03) 613-620
• 5 Creager AE, Kleven AD, Kesimoglu ZN. et al. The impact of pre-operative healthcare utilization on complications, readmissions, and post-operative healthcare utilization following total joint arthroplasty. J Arthroplasty 2022; 37 (03) 414-418
• 6 Krumholz HM. Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368 (02) 100-102
• 7 Schilling PL, Bozic KJ. Development and validation of perioperative risk-adjustment models for hip fracture repair, total hip arthroplasty, and total knee arthroplasty. J Bone Joint Surg Am 2016; 98 (01) e2
• 8 Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty?. Clin Orthop Relat Res 2017; 475 (12) 2926-2937
• 9 Keehan SP, Cuckler GA, Sisko AM. et al. National health expenditure projections, 2014-24: spending growth faster than recent trends. Health Aff (Millwood) 2015; 34 (08) 1407-1417
• 10 Zhao S, Kendall J, Johnson AJ, Sampson AAG, Kagan R. Disagreement in readmission rates after total hip and knee arthroplasty across data sets. Arthroplast Today 2021; 9: 73-77
• 11 McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation 2015; 131 (20) 1796-1803
• 12 Sabbatini AK, Joynt-Maddox KE, Liao JM. et al. Accounting for the growth of observation stays in the assessment of medicare's hospital readmissions reduction program. JAMA Netw Open 2022; 5 (11) e2242587
• 13 Desai NR, Ross JS, Kwon JY. et al. Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. JAMA 2016; 316 (24) 2647-2656
• 14 Wasfy JH, Zigler CM, Choirat C, Wang Y, Dominici F, Yeh RW. Readmission rates after passage of the hospital readmissions reduction program: a pre-post analysis. Ann Intern Med 2017; 166 (05) 324-331
• 15 Bozic KJ, Kamath AF, Ong K. et al. Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 2015; 473 (06) 2131-2138