Abstract
Objectives: To ascertain the frequency and causes of both re-admissions and re-visits (i.e. those not requiring overnight stay) to the hospital following primary and revision TKRs.
Methods: All TKRs performed between April 2007 and March 2008 were included in the study. Mean follow-up period was 9 months (range 3–15 months). Patient data was accessed via computerized patient information systems giving access to the details of inpatient admissions, A& E attendances, laboratory results, radiology reports and clinic letters. Pattern of re-hospitalisation with regards to the cause and time period post-surgery was recorded as well.
Results: Total number of primary TKRs performed in the year was 839 and the re-admission and re-visit rates were 8.22% and 4.17% respectively. The overall re-hospitalisation rate was 12.4%. Most common causes for readmission were pain/stiffness requiring MUA (1.67%) and superficial infections (1.55%). Majority of the revisits were for continuing joint pain (1.67%) and suspected DVT.
Total number of revision TKRs was 136 with a readmission and re-visit rate of 9.7% and 1.49% respectively. The total re-hospitalisation rate was 11.19%. Deep Infections were a prominent cause of readmission (4.4%).
Discussion: Around half (49.5%) of re-hospitalisations were seen in an Orthopaedic setting, the remainder presented to A& E (19.23%), Medical Assessment Units (16.35%) or General Medical Wards (7.7%). Following a primary TKR DVT/PE rates were less than 1% (0.83%). A vast majority (48.6%) of all re-admissions however, occurred within 28 days of discharge. The tradition of seeing patients for the first time in clinic postoperatively after 6–12 weeks may not be appropriate if the majority of re-admissions occur within 28 days.
Conclusion: Idiopathic joint pain and early infections are a major cause of re-hospitalisation. Re-scheduling the first follow-up appointment within the first month after a joint replacement can decrease the overall re-hospitalisation rates and also decrease the impact of these patients on other departments.
Correspondence should be addressed to: BASK c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
