Abstract
A national quality improvement initiative identified potentially avoidable complications, including venous thromboembolism (VTE) as “never events.” While the intent of this designation was to improve system-wide performance and to decrease medical costs, its value in total joint arthroplasty has not been defined. We performed this study to assess the relative incidence of VTE related admissions following TKA, the relative costs associated with care directed towards this complication, and compliance with SCIP VTE prophylaxis guidelines. From a total of 2,221 TKA procedures accomplished over a 5 year interval, we identified 121 hospital readmissions (5.4 percent). Primary readmission diagnoses were obtained from hospital coding and physician medical record documentation. Readmissions were categorised into five major complication types: 1) limited motion, 2) noninfectious wound complications, 3) bleeding complications, 4) deep infections, and 5) VTE events. VTE chemoprophylaxis was reviewed to determine the agent utilised, therapeutic level, and duration. Hospital records were assessed to determine whether additional surgeries or other procedures were accomplished and whether patients received allogeneic transfusions during their readmission. Direct costs of readmission care were obtained from hospital reimbursement records. Limited motion (18%), non-infectious wound complication (14%), surgical site infection (10%), and bleeding (10%) were the most common reasons for readmission. VTE events were less frequent (3%) and all occurred despite standard of care prophylaxis. The cost to manage bleeding, wound complications, infection, and limited motion each exceeded the cost of VTE. These results challenge the identification of VTE as a “never event.”
