Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients
Aims: It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. Methods: We analyzed linked hospital and death recor...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2024-01-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0118.R1 |
| _version_ | 1797341747496353792 |
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| author | Md S. R. Shawon Xingzhong Jin Mark Hanly Richard de Steiger Ian Harris Louisa Jorm |
| author_facet | Md S. R. Shawon Xingzhong Jin Mark Hanly Richard de Steiger Ian Harris Louisa Jorm |
| author_sort | Md S. R. Shawon |
| collection | DOAJ |
| description | Aims: It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. Methods: We analyzed linked hospital and death records for residents of New South Wales, Australia, aged ≥ 18 years who had an emergency readmission within 90 days following THA or TKA surgery between 2003 and 2022. Multivariable modelling was used to identify factors associated with non-index readmission and to evaluate associations of readmission destination (non-index vs index) with 90-day and one-year mortality. Results: Of 394,248 joint arthroplasty patients (THA = 149,456; TKA = 244,792), 9.5% (n = 37,431) were readmitted within 90 days, and 53.7% of these were admitted to a non-index hospital. Non-index readmission was more prevalent among patients who underwent surgery in private hospitals (60%). Patients who were readmitted for non-orthopaedic conditions (62.8%), were more likely to return to a non-index hospital compared to those readmitted for orthopaedic complications (39.5%). Factors associated with non-index readmission included older age, higher socioeconomic status, private health insurance, and residence in a rural or remote area. Non-index readmission was significantly associated with 90 day (adjusted odds ratio (aOR) 1.69; 95% confidence interval (CI) 1.39 to 2.05) and one-year mortality (aOR 1.31; 95% CI 1.16 to 1.47). Associations between non-index readmission and mortality were similar for patients readmitted with orthopaedic and non-orthopaedic complications (90-day mortality aOR 1.61; 95% CI 0.98 to 2.64, and aOR 1.67; 95% CI 1.35 to 2.06, respectively). Conclusion: Non-index readmission was associated with increased mortality, irrespective of whether the readmission was for orthopaedic complications or other conditions. Cite this article: Bone Jt Open 2024;5(1):60–68. |
| first_indexed | 2024-03-08T10:22:29Z |
| format | Article |
| id | doaj.art-3c3a2ef2caea4b0c8bb450be56c12c98 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-03-08T10:22:29Z |
| publishDate | 2024-01-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-3c3a2ef2caea4b0c8bb450be56c12c982024-01-27T12:16:40ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622024-01-0151606810.1302/2633-1462.51.BJO-2023-0118.R1Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patientsMd S. R. Shawon0https://orcid.org/0000-0003-4502-1457Xingzhong Jin1https://orcid.org/0000-0003-4293-8665Mark Hanly2https://orcid.org/0000-0002-9279-7453Richard de Steiger3https://orcid.org/0000-0002-1276-2040Ian Harris4https://orcid.org/0000-0003-0887-7627Louisa Jorm5https://orcid.org/0000-0003-0390-661XCentre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, AustraliaCentre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, AustraliaCentre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, AustraliaDepartment of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, AustraliaSchool of Clinical Medicine, University of New South Wales, Sydney, New South Wales, AustraliaCentre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, AustraliaAims: It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. Methods: We analyzed linked hospital and death records for residents of New South Wales, Australia, aged ≥ 18 years who had an emergency readmission within 90 days following THA or TKA surgery between 2003 and 2022. Multivariable modelling was used to identify factors associated with non-index readmission and to evaluate associations of readmission destination (non-index vs index) with 90-day and one-year mortality. Results: Of 394,248 joint arthroplasty patients (THA = 149,456; TKA = 244,792), 9.5% (n = 37,431) were readmitted within 90 days, and 53.7% of these were admitted to a non-index hospital. Non-index readmission was more prevalent among patients who underwent surgery in private hospitals (60%). Patients who were readmitted for non-orthopaedic conditions (62.8%), were more likely to return to a non-index hospital compared to those readmitted for orthopaedic complications (39.5%). Factors associated with non-index readmission included older age, higher socioeconomic status, private health insurance, and residence in a rural or remote area. Non-index readmission was significantly associated with 90 day (adjusted odds ratio (aOR) 1.69; 95% confidence interval (CI) 1.39 to 2.05) and one-year mortality (aOR 1.31; 95% CI 1.16 to 1.47). Associations between non-index readmission and mortality were similar for patients readmitted with orthopaedic and non-orthopaedic complications (90-day mortality aOR 1.61; 95% CI 0.98 to 2.64, and aOR 1.67; 95% CI 1.35 to 2.06, respectively). Conclusion: Non-index readmission was associated with increased mortality, irrespective of whether the readmission was for orthopaedic complications or other conditions. Cite this article: Bone Jt Open 2024;5(1):60–68.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0118.R1total hip arthroplastytotal knee arthroplastyjoint replacement90-day readmissionnon-index readmissiontotal joint replacement surgeryarthroplasty surgerytotal hip or knee arthroplastyorthopaedic complicationstotal hip or knee arthroplastyorthopaedic conditionsorthopaedic conditionscomorbiditieslogistic regression modelst-test |
| spellingShingle | Md S. R. Shawon Xingzhong Jin Mark Hanly Richard de Steiger Ian Harris Louisa Jorm Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients Bone & Joint Open total hip arthroplasty total knee arthroplasty joint replacement 90-day readmission non-index readmission total joint replacement surgery arthroplasty surgery total hip or knee arthroplasty orthopaedic complications total hip or knee arthroplasty orthopaedic conditions orthopaedic conditions comorbidities logistic regression models t-test |
| title | Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients |
| title_full | Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients |
| title_fullStr | Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients |
| title_full_unstemmed | Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients |
| title_short | Readmission to a non-index hospital following total joint replacement: prevalence and association with mortality in 394,248 Australian patients |
| title_sort | readmission to a non index hospital following total joint replacement prevalence and association with mortality in 394 248 australian patients |
| topic | total hip arthroplasty total knee arthroplasty joint replacement 90-day readmission non-index readmission total joint replacement surgery arthroplasty surgery total hip or knee arthroplasty orthopaedic complications total hip or knee arthroplasty orthopaedic conditions orthopaedic conditions comorbidities logistic regression models t-test |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.51.BJO-2023-0118.R1 |
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