Considerations for Readmissions in Simultaneous Bilateral Total Knee Arthroplasty

Author(s): Brian B. Begley, Justin Miller, Christopher J. Mazzei, Francis C. Maguire, Tyler Hoskins, James C. Wittig

Introduction: Bilateral Total Knee Arthroplasty (BTKA) procedures bestow challenges to patients in their recovery. Studies show that patients undergoing a simultaneous BTKA procedure have a significantly increased need for blood transfusion and postoperative rehabilitation and are at greater risk for complications. These challenges may lead to readmission to the hospital in this particular population. The aim of this study was to examine the differences and demographics of readmitted BTKA patients.

Methods: After gaining approval from our Institutional Review Board, a retrospective review of our hospital’s Electronic Medical Records (EMR) was performed for patients who underwent a simultaneous BTKA procedure at Morristown Medical Center (MMC) between August 2018 and September 2020. In total, 328 procedures were identified during this period. Demographic and clinical data was abstracted from the hospital EMR for the identified patients. Readmission events were identified at 30 days, 90 days, and one year postoperatively from the patients billing abstracts. Readmissions were determined following the date of discharge. Basic and univariate statistics for significance were performed using the statistical software Minitab (State College, PA, USA). P-value results <0.05 were considered significant.

Results: Of the 328 simultaneous BTKA procedures abstracted, 15 patients with at least one readmission event were identified. This readmitted population shared similar demographics with non-readmitted BTKA patients. A greater BMI trended toward statistical significance in readmitted BTKA patients (34.08 v. 31.41; P=0.093). ASA scores were found to trend to statistical significance as well. More non-readmitted patients received an ASA score of 2 (73.16% v. 53.33%; P=0.131), while more readmitted patients received an ASA score of 3 (40.00% v. 21.73%; P=0.155). The only ASA score of 4 assigned was to a readmitted BTKA patient. (6.67% v. 0%; P=0.046).

Readmitted BTKA patients exhibited a statistically significant greater median observed length of stay (LOS) than patients who were not readmitted (4 v. 3 days; P=0.05). The indexed LOS (determined by a risk stratification algorithm) was expectedly greater and trended toward statistical significance in readmitted patients as well (2 v. 1.5 days; P=0.178). There was no significant difference observed in discharge disposition between the two populations.

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