Re-admission after primary total joint arthroplasty among commercially insured population: A claim-based descriptive analysis

Introduction: Re-admissions to hospitals after major joint surgeries carry cost and quality implications. Our objective was to assess re-admissions from index hospital admission with discharge to skilled nursing facilities (SNFs) following primary total-hip arthroplasty (THA) or total-knee arthroplasty (TKA) for a statewide commercially insured population.

Materials/Methods: We used administrative claims and membership data to identify hospital admissions with a primary THA or TKA in 2012. Demographics, risk, comorbidities, utilization, and re-admission results were examined separately for discharge-disposition to SNFs and non-SNFs. Of the 6,214 hospital admissions identified, 354 were discharged to SNFs.

Results: In both THA and TKA, patients discharged to SNFs had higher re-admission rates and average cost per re-admission visits than those discharged to non-SNFs. Patients were older, more likely to be female, and of higher risk. For THA discharged to SNFs vs. non-SNFs, 30-day re-admission rate was 5.9% vs. 2.5% (P=0.10), and average cost per 30-day re-admission visit was $1,845 vs. $730 (P=0.09). The 60-day re-admission rate was 10.4% vs. 4.8% (P<0.05) and average cost per 60-day re-admission visit was $3,233 vs. $1,372 (P<0.05). For TKA, 30-day re-admission rate was 5.0% vs. 2.4% (P<0.05) and average cost per 30-day re-admission visit was $1,505 vs. $676 (P=0.07). The 60-day re-admission rate was 6.4% vs. 4.7% (P=0.32) and average cost per 60-day re-admission visit was $1,900 vs. $1,299 (P=0.24).

Discussion: Targeting efforts to improve quality of care for THA and TKA discharged to SNFs are needed, and they have the potential to lower health care costs by reducing re-admissions.