BERLIN — Researchers in the United Kingdom recently found that readmission after total knee replacement and total hip replacement happened for a number of reasons. Most of them were non-surgical in nature and thus out of the control of hospitals and were not due to patients either being discharged prematurely or inappropriately.
According to results of their study, a significant number of knee and hip replacement procedures were coded improperly, which could have significant financial implications.
To determine reasons for 30-day readmissions following elective primary total knee and total hip replacement (TKR and THR, respectively) — as well as surgical vs. non-surgical causes and coding accuracy for readmissions — Jennifer Coward, a fifth-year medical student at the University of Leicester, and colleagues examined Hospital Episodes Statistics 30-day readmission data and electronic discharge summaries collected at the University Hospital at Leicester between April 2010 to April 2011.
“Ten percent were readmitted within 30 days of [THR] and 4% were readmitted after having a [TKR],” Coward said.
This amounted to 30 patients with TKR and 65 patients with THR.
Regarding TKR, the mean patient age was 72 years with a mean time of 10 days to readmission (range: 1 day to 27 days). The sample size consisted of 30 knees, but investigators could only use 26 of them because four knee surgeries were coded as revision TKRs, Coward noted.
This resulted in an actual readmission rate of 3.5%, as 13% of the 30 knees had been incorrectly coded.
“So what were the reasons for readmissions after having a [TKR]? There were 16 non-surgical causes, six surgical causes and four were inconclusive,” Coward said, listing pulmonary embolism, lower-limb deep vein thrombosis (DVT) and low hemoglobin as the surgical causes (two each).
Non-surgical reasons for readmissions, which covered 62% of cases, included three cases of non-DVT leg swelling, two cases of syncope, two cases of hematuria, among others.
“Roughly 60% of [THR readmissions] and 60% of [TKR readmissions] were for non-surgical postoperative reasons,” Coward concluded. “We also found 60% of readmitted hips were wrongly coded, with around one in 10 knees being wrongly coded — which could have a huge, significant financial impact within individual National Health Service trusts.”
Coward J, Martin H, Ali M, et al. Reasons for 30 day readmission rates following primary total hip and knee replacements. Paper #12-2332. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.
Disclosures: The authors have no relevant financial disclosures.