Clinical Outcomes and Costs Within 90 Days of Primary or Revision Total Joint Arthroplasty

• Published in: The Journal of arthroplasty Vol. 31; no. 7; pp. 1400 - 1406.e3
• Main Authors: Nichols, Christine I., MA, MBA, Vose, Joshua G., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Knee - economics; Comorbidity; Cost burden; Female; Health Care Costs; Humans; Length of Stay; Logistic Models; Male; Medicare; Middle Aged; Orthopedics; Patient Discharge; Patient Readmission - economics; Postoperative Period; Post–acute care; Proportional Hazards Models; Readmission; Reoperation; Retrospective Studies; Risk Factors; Skilled Nursing Facilities; Total joint arthroplasty; United States; Cost burden; Post–acute care; Readmission; Total joint arthroplasty; Risk factors
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.01.022

Abstract Background This study evaluated the factors and costs associated with discharge destination and readmission, within 90 days of surgery, for primary or revision total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods This retrospective database analysis used health care claims from the Truven MarketScan Database (2009-2013). Patients were selected if aged ≥18 years, with continuous health plan enrollment from 3-month baseline through 3-month follow-up. Logistic regression and Cox proportional hazard models were used to analyze factors associated with discharge destination and risk of readmission. Total 90-day costs were calculated for different patient pathways of care, dependent on complications, discharge destination, and readmission status. Results A total of 323,803 primary TKA, 25,354 revision TKA, 159,390 primary THA, and 17,934 revision THA cases met selection criteria. All-cause complications occurred in 2.5%, 37.2%, 2.6%, and 35.0% of each cohort. Complications, transfusions, and length of stay ≥3 days were associated with greater odds of discharge to home with home health services or skilled nursing facility (SNF) vs home under self-care ( P  < .001 all cohorts), whereas discharge to home with home health services or SNF was associated with greater risk of readmission ( P < .05 for all cohorts except one). The ratio of total 90-day costs for the highest- (revision, SNF, readmission) vs lowest-cost (primary, home under self-care, no readmission) care pathways ranged from 1.8 to 2.2. Conclusion As Medicare payment policy for total joint arthroplasty shifts toward bundling, an awareness of factors associated with outlier costs will be requisite to remain profitable.