In the study, “Improving Quality and Decreasing Cost by Reducing Readmissions in Patients Undergoing Total Joint Arthroplasty,” conducted by the Nebraska Medical Center, several risk factors have been found to contribute to the complication and readmission rates following total joint arthroplasty (TJA), such as obesity, diabetes, and malnutrition. All of these are risk factors in hip and knee replacement readmission as well.
A. Brion Gardner, MD, an orthopaedic surgeon for The Centers for Advanced Orthopaedics in Bethesda, Maryland, says there are a variety of reasons that an individual with a hip or knee replacement may be readmitted. The most serious cause is experiencing a heart attack shortly after surgery, and some patients with preexisting conditions may be more at risk for this.
“Other grounds for readmission include uncontrolled pain, a wound that has drained or is infected, or a blood clot,” he says. “Patients may also be readmitted if there is suspicion of a blood clot or preliminary infection.”
Brian Hallstrom, MD, is co-director of Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), a Blue Cross Blue Shield of Michigan-sponsored, statewide collaborative of hospitals, orthopaedic surgeons, and medical professionals; and clinical assistant professor of orthopaedic surgery at the University of Michigan.
“The most common reasons for hip replacement readmission are fracture, dislocation, blood clots, or other medical complications,” he says. “Knee replacement patients are more likely to come in with pain or blood clots. In both cases, the medical returns are often associated with the patients who experience other medical issues, such as diabetes or heart disease.”
Further, constipation is a common problem among post-surgical patients who are placed on opioids, and bowel problems can also be a reason for return to the ED and readmission.