Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database

被引：12

作者：

Urish, Kenneth L. ^{[1
,2
,3
,4
]}

Qin, Yongmei ^{[5
]}

Salka, Bassel ^{[5
]}

Li, Benjamin Y. ^{[5
]}

Borza, Tudor ^{[6
]}

Sessine, Michael ^{[5
]}

Kirk, Peter ^{[5
]}

Hollenbeck, Brent K. ^{[5
]}

Helm, Jonathan E. ^{[7
]}

Lavieri, Mariel S. ^{[8
]}

Skolarus, Ted A. ^{[9
]}

Jacobs, Bruce L. ^{[10
]}

机构：

[1] Univ Pittsburgh, Magee Womens Hosp, Bone & Joint Ctr, Arthrit & Arthroplasty Design Grp,Med Ctr, Pittsburgh, PA 15232 USA

[2] Univ Pittsburgh, Dept Orthopaed Surg, Dept Bioengn, Pittsburgh, PA 15232 USA

[3] Univ Pittsburgh, Clin & Translat Sci Inst, Pittsburgh, PA 15232 USA

[4] Carnegie Mellon Univ, Dept Biomed Engn, Pittsburgh, PA 15213 USA

[5] Univ Michigan, Dept Urol, Dow Div Urol Hlth Serv Res, Div Oncol, Ann Arbor, MI 48109 USA

[6] Univ Wisconsin, Dept Urol, Sch Med & Publ Hlth, William S Middleton Mem Vet Hosp, Madison, WI USA

[7] VA Ann Arbor Healthcare Syst, Hlth Serv Res & Dev, Ctr Clin Management Res, Ann Arbor, MI USA

[8] Univ Michigan, Dept Ind & Operat Engn, Ann Arbor, MI 48109 USA

[9] Univ Michigan, Dept Urol, Div Oncol,VA Ann Arbor Healthcare Syst, Dow Div Urol Hlth Serv Res Hlth Serv Res & Dev,Ct, Ann Arbor, MI 48109 USA

[10] Univ Pittsburgh, Dept Urol, Pittsburgh, PA 15232 USA

来源：

ANNALS OF TRANSLATIONAL MEDICINE | 2020年 / 8卷 / 11期

关键词：

Total knee arthroplasty (TKA); readmission; revision procedure; Comprehensive Care for Joint Replacement; Nationwide Readmission Database (NRD); TOTAL JOINT ARTHROPLASTY; HOSPITAL READMISSION; HIP; OUTCOMES; COSTS; RISK; INFECTION; FAILURE; REASONS;

D O I：

10.21037/atm-19-3463

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background: After release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost. Methods: We utilized the 2013 Nationwide Readmission Database (NRD) to examine national readmission and revision rates, the reasons for revision procedures, and associated costs for elective TKA procedures. As data are not linked across years, we examined revision rates for TKA completed in the month of January by capturing revision procedures in the subsequent following 11-month period to approximate a 1-year revision rate. Diagnosis and procedure codes for revision procedures were collected. Average readmission and revision procedure costs were then calculated, and the cost distributed across the entire TKA population. Results: We identified 20,851 patients having TKA surgery. The mean unadjusted 30-and 90-day TKA readmission rates were 3.4% and 5.8%, respectively. In contrast, the mean unadjusted 3-month and approximate 1-year reoperation rates were 1.0% and 1.6%, respectively. The most common cause for revision was periprosthetic joint infection, which accounting for 62% of all reported revision procedures. The mean payment for 90-day readmission was roughly half ($ 10,589 +/-$11,084) of the mean inpatient payment for single reoperation procedure at 90 days ($20,222 +/-$17,799). Importantly, nearly half (46%) of all 90-day readmissions were associated with a reoperation event within the first year. Conclusions: Readmission following TKA is associated with a 1-year reoperation in approximately half of patients. These reoperations represent a significant patient burden and have a higher per episode cost. Early reoperation may represent a more clinically relevant target for quality improvement and cost containment.

引用

页数：11

共 33 条

[1] Readmission Following Total Knee Arthroplasty Venous Thromboembolism as a "Never Event" Is a Counterproductive Misnomer [J].