Zmistowski et al evaluated risk factors for unplanned hospital readmission following a total knee or hip replacement. These can help to identify a person who may require more aggressive management. The authors are from Thomas Jefferson University in Philadelphia.
Patient selection: total knee or total hip replacement
Outcome: unplanned readmission within 90 days
Common causes for readmission:
(1) infection
(2) stiffness
(3) cardiovascular
(4) venous thromboembolism
(5) wound
Patient risk factors:
(1) male gender
(2) Black race
(3) lower age
(4) short distance between home and the hospital (within 10 kilometers)
Procedure risk factors:
(1) unilateral replacement
(2) total knee replacement
Problem related:
(1) discharged as continued care inpatient (as opposed to skilled nursing facility or home)
(2) increased duration of hospital stay (used >= 4 days based on Table III)
where:
• The impact of distance may be interpreted in several ways including (a) a shorter distance makes it easier to return and (b) a short distance to an urban hospital may indicate a lower socioeconomic status.
• 11% of hips and 31% of knees involved bilateral replacements.
• The selection criteria for a bilateral knee replacement may be more stringent than for a unilateral procedure, favoring a person in better health.
• The study is based on data from 2004 to 2008. A person might have been readmitted who would not be readmitted today.
• A patient rehabilitated as an inpatient would have a longer hospital stay.
