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Nationwide 30-Day Readmissions After Elective Orthopedic Surgery: Reasons and Implications

Introduction: Reducing readmissions after orthopedic surgery is important for decreasing hospital costs and patient morbidity. Our goals were to establish national rates and reasons for 30-day readmissions after common elective orthopedic procedures. Methods: Patients undergoing total knee arthroplasty, total hip arthroplasty, posterior lumbar fusion, anterior cervical discectomy and fusion, or total shoulder arthroplasty were identified from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day readmission rates, timing, and reasons were recorded for each procedure. Multivariate analysis was used to identify risk factors of readmissions. Results: A total of 3.8% of patients had an all-cause readmission, 3.6% had an unplanned readmission, and 2.4% had an unplanned readmission related to surgery (URRS). The most common reason was surgical site complication followed by venous thromboembolism and bleeding. Only 3.2% of all patients with a URRS were readmitted because of a predischarge complication. Independent predictors of URRS were current smoking, any inpatient complication, and non–home discharge. Conclusions: Unplanned readmissions were a proxy for new postdischarge complications rather than a re-exacerbation of previous inpatient events. Emphasis should be on more effective prevention strategies for surgical site infections, continuing to prevent inpatient complications and focusing on home discharge.