Abstract
Introduction
Reducing readmissions after total joint arthroplasty (TJA) is challenging. Pre-operative risk stratification and optimization pre surgical care may be helpful in reducing readmission rates after primary TJA. Assessment of the predictive value of individual modifiable risk factors without a tool to properly stratify patients may not be helpful to the surgical community to reduce the risk of readmission. We developed a scoring system: Readmission Risk Assessment Tool (RRAT) as part of a Perioperative Orthopaedic Surgical Home model that allows for risk stratification in patients undergoing elective primary TJA at our institution. We analyzed the relationship between the RRAT score and readmission following primary hip or knee arthroplasty.
Methods
The RRAT, which is scored incrementally based on the number and severity of modifiable comorbidities was used to generate readmission scores for a cohort of 207 readmitted and 2 cohorts of 234 (random and age-matched) non-readmitted patients each. Regression analysis was performed to assess the strength of association between individual risk factors, RRAT score and readmissions. We also calculated the odds and odds ratio (OR) at each level of RRAT score to identify patients with relatively higher risk of readmission.
Results
There were 207(2.08%) 30-day readmissions in 9,930 patients over a 6-year period (2008 to 2013). Surgical site infection was the most common cause of readmission (93 cases, 45%). The median RRAT scores were 3 (IQR: 1, 4) and 1 (IQR: 0, 2) for readmitted group and non-readmitted group respectively. The RRAT score was significantly associated with readmission with odds ratio between 1.5 and 1.9 under various model assumptions. A RRAT score of 3 or higher resulted in higher odds of readmission.
Discussion and Conclusion
Population health management, cost-effective care and optimization of outcomes to maximize value are the new maxims for healthcare delivery in the United States. The RRAT has a significant association with readmission following joint arthroplasty and could potentially be a clinically meaningfully tool for risk mitigation.
