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The High Cost of Exposure: Examining the Link between Preoperative Hospital Visits, Readmissions, and Healthcare Utilization in Hip Replacement Surgery

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The AAOS meeting this year, as it is each year, was one of the highlights of the global conference schedule and one that I was highly anticipating. Not only is this meeting an excellent opportunity to connect and exchange ideas among respected colleagues, it is also filled with new and emerging information essential for the practicing orthopedic surgeon. I wanted to take a moment to talk briefly regarding our institution's research presented during this year’s proceedings concerning the optimization of healthcare utilization following total joint arthroplasty (TJA) surgery, specifically total hip arthroplasty (THA), and the impact of hospital exposure prior to THA on subsequent revision procedures.

Although complications following THA are relatively rare, both the continued growth in the utilization of these surgeries as well as the high costs of revision THA have highlighted this procedure as having considerable influence on healthcare costs in the United States. Importantly the Medicare Hospital Readmissions Reduction Program (HRRP) has identified readmissions as an integral quality metric, requiring any readmission between 30-90 days of surgery be the financial responsibility of the hospital or institution. This is a considerable economic challenge for arthroplasty surgeons, as the annual costs for 90-day readmissions following total hip arthroplasty (THA) alone totals nearly half a billion dollars. This has led to a general focus within the field of joint replacement surgery on identifying the risk factors prior to surgery that may impact a patient’s postoperative recovery and long-term outcomes. We know that one such risk factor with adverse implications on outcomes is exposure to healthcare facilities in the immediate period prior to THA, especially within 90 days. This has been shown to impact discharge destination following surgery and increase the risk for readmission in the immediate postoperative period, although the impact on revision THA remains unclear.

In our study, which was presented at the annual meeting this year, we provided further evidence supporting patients with prehospital exposure prior to THA having a statistically significantly higher risk for both 30- and 90-day readmission. While our cohort with prehospital exposure demonstrated an increased risk for facility discharge and readmission following THA, we importantly found no increased risk of revision THA whether a patient had prior hospital exposure or not, however, our study did not further examine the economic impact of revision THA between patients with prehospital exposure vs. those without. Nevertheless, the impact of hospital exposure prior to THA and its subsequent impact on postoperative events remains a concern. Moving forward, surgeons may need to consider a temporary recovery period following a prior hospital exposure event before proceeding with THA in order to better optimize postoperative outcomes.

Dr. Schwarzkopf and Mr. Ward have no conflicts of interest to report.

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