Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey

Madhur Chhabra; Diana Perriman; Christine Phillips; Anne Parkinson; Nicholas Glasgow; Kirsty Douglas; Darlene Cox; Paul Smith; Jane Desborough

doi:10.1136/bmjopen-2021-053831

Understanding factors affecting 30-day unplanned readmissions for patients undergoing total knee arthroplasty (TKA): the ACT Transition from Hospital to Home Orthopaedics Survey

BMJ Open. 2022 Apr 11;12(4):e053831. doi: 10.1136/bmjopen-2021-053831.

Authors

Madhur Chhabra¹, Diana Perriman^{2

3}, Christine Phillips³, Anne Parkinson⁴, Nicholas Glasgow³, Kirsty Douglas³, Darlene Cox⁵, Paul Smith^{2

3}, Jane Desborough⁴

Affiliations

¹ Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia madhur.chhabra@anu.edu.au.
² Trauma and Orthopaedic Research Unit, ACT Health, Canberra City, Australian Capital Territory, Australia.
³ Australian National University Medical School, Canberra, Australian Capital Territory, Australia.
⁴ Department of Health Services Research and Policy, Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ Health Care Consumers Association, ACT, Canberra, Australian Capital Territory, Australia.

Abstract

Objectives: The aim of this study was to investigate factors associated with unplanned 30-day readmissions following a total knee arthroplasty (TKA), including association with post-hospital syndrome, patient enablement and transition from hospital to home.

Design, setting and participants: A cross-sectional written survey of public and private patients attending a 6-week follow-up appointment after TKA at one of four clinical services in the Australian Capital Territory (ACT) between 1 February 2018 and 31 January 2019. Multiple logistic regression analyses were used to measure associations between patient, hospital and transitional care factors with unplanned 30-day readmissions, while controlling for known confounders.

Results: Of the 380 participants who completed the survey (n=380, 54% of TKAs undertaken over the study period), 3.4% (n=13; 95% CI: 1.8 to 5.8) were subsequently readmitted within 30 days of discharge after a primary hospitalisation. Public patients were significantly more likely to be readmitted within 30 days compared with private patients (adjusted OR=6.31, 95% CI: 1.59 to 25.14, p=0.009), and patients who attended rehabilitation were significantly less likely to be readmitted within 30 days of discharge than those who did not (adjusted OR=0.16, 95% CI: 0.04 to 0.57, p=0.005). There were no associations between post-hospital syndrome or patient enablement and 30-day readmissions in this study.

Conclusion: Reasons underlying the difference in unplanned readmission rates for public versus private patients need to be explored, including differences in surgical waiting times and the consequences for impairment and disease complexity. Strategies to foster increased participation post-surgical rehabilitation programmes need to be developed as an avenue to mitigate the burden of unplanned 30-day readmissions on individuals and health systems.

Keywords: health policy; knee; quality in health care.

MeSH terms

Arthroplasty, Replacement, Knee*
Australia
Cross-Sectional Studies
Hospital to Home Transition
Hospitals
Humans
Orthopedics*
Patient Discharge
Patient Readmission
Postoperative Complications / surgery
Retrospective Studies
Risk Factors