Readmission Diagnoses Following Total Hip Replacement in Relationship to Insurance Payer Status
HarmandeepSingh, MD, Robert S. White, MD, Noelle S. Arroyo, BA, Licia K. Gaber-Baylis, BA, and Zachary A. Turnbull, MD
Total hip replacements (THR) are the sixth most common surgical procedure performed in the United States .
Although THR provides marked improvement of quality of life for patients, it is not without risk. Hospital readmission rates for THR are estimated at between 4.0% to 10.9% .
Postsurgical readmissions are associated with other surgical quality measures including surgical mortality and Hospital Quality Alliance Surgical Care score .
Readmissions can be influenced by the overall quality of care received due to various socioeconomic factors.
To assess the association, if any, between present-on-admission (POA) diagnoses of the readmission stay and patient’s insurance status for 30-day and 90-day readmissions in adults undergoing THR.
From 2007-2011, 297,103 patients underwent a THR in California, Florida, and New York
274,851 patients were ages 18 and older with available primary insurance payer and readmission data.
The most common reasons for 30-day readmissions compared to private insurance:
wound infection (15.7% Private Insurance; 19.3% Uninsured)
atrial fibrillation (5.9% Private Insurance; 18.4% Medicare)
urinary tract infection (6.3% Private Insurance; 13.3% Medicare)
pneumonia (3.4% Private Insurance; 6.9% Medicare).
The most common reasons for 90-day readmissions compared to private insurance:
atrial fibrillation (5.5% Private Insurance; 16.9% Medicare)
urinary tract infection (4.5% Private Insurance; 12.0% Medicare)
wound infection (9.3% Private Insurance; 12.1% Uninsured)
pneumonia (2.7% Private Insurance; 6.2% Medicare)
Common reasons for readmission, including wound infection, atrial fibrillation, UTI, and pneumonia, were present at higher rates in Medicare and/or uninsured patients when compared to private insurance patients.
Previous literature has shown that infections are among the most common causes of readmission after THR .
The association of higher readmission rate due to specific POA diagnoses in patients with Medicare may be due to various socioeconomic factors, which can be a source of confounding.
Future research should focus on further delineating and addressing socioeconomic disparities in readmission after THR.
This study showed that a patient’s insurance payer status impacts 30-day and 90-day readmission diagnoses after THR.