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Study Finds Causes of Hospital Readmissions After Joint Replacements

Infections cited as primary surgical complications

A new study by researchers at New York University (NYU) Langone’s Hospital for Joint Diseases has identified common causes of hospital readmissions after total hip and knee arthoplasty procedures. By finding these common causes, the researchers believe quality can be increased and hospital costs decreased.

The findings were presented March 27 at the American Academy of Orthopaedic Surgeons’ annual meeting in Las Vegas, Nevada.

The patients were part of the Bundled Payment for Care Initiative from the Centers for Medicare and Medicaid Services (CMS), a government pilot program in which hospitals are paid for the quality of procedures rather than the quantity. One way to measure quality is by examining hospital readmission rates.

The researchers studied 721 patients admitted to NYU Langone’s Hospital for Joint Diseases between January and December 2013 for a total hip arthoplasty (THA) or a total knee arthoplasty (TKA). Of those patients, 80 (11%) had to be re-admitted within 90 days.

THA and TKA readmissions due to surgical complications accounted for 54% and 44% of the indications for readmissions, respectively. Surgical complications included infection (11), wound complications (eight), bleeding (seven), periprosthetic fracture (five), dislocations (four), and postsurgical pain (four). The average costs of readmission for surgical complications were $36,038 for THA and $61,049 for TKA.

Medical complications included gastrointestinal disease (11); pulmonary disease (eight); genitourinary/renal complications (six); hematologic (six), cardiovascular (three), or endocrine disorders (two); syncope (two); rheumatologic disorders (one); lumbago (one); and an open ankle wound (one). The average costs of medical complications were $22,775 for THA and $10,283 for TKA patients.

“While some complications are unavoidable, we are proud of our low readmission rates at the Hospital for Joint Diseases, and by identifying the causes of readmission, we hope to reduce our rates even further,” said co-author Joseph Bosco, MD. “As bundled payment programs are implemented more widely nationwide, other U.S. hospitals will follow our example and implement strategies to boost quality and reduce medical costs.”

Source: EurekAlert; March 27, 2015.

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