Bido Jennifer, Torres Ricardo, Kaidi Austin C, Rodriguez Samuel, Rodriguez Jose A
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2024 May;20(2):187-194. doi: 10.1177/15563316241230052. Epub 2024 Feb 13.
Bundled payments for total joint arthroplasty (TJA) were instituted by the Centers for Medicare and Medicaid Services (CMS) to reimburse providers a lump sum for operative and 90-day postoperative costs. Gaining a better understanding of which TJA patients are at risk for early return to the operating room (OR) is critical in preoperative optimization of those with modifiable risks, which could improve bundled-payment performance. : We sought to identify the most common reason for readmissions, as well as patient characteristics and costs, associated with early return to the OR among TJA patients. : This was a retrospective cohort study of Medicare patients who had undergone primary total hip or knee arthroplasty (THA or TKA) between 2013 and 2018 at a tertiary care hospital. We used the CMS research identifiable files database to identify the most common reasons for readmissions and revisions within 90 days of surgery. Total billing claims were used to determine the cost of early readmissions and revisions. Multivariate regression analysis was used to determine the characteristics associated with early readmission or revision. : Out of 20 166 primary TJA patients identified, we found 1349 readmissions (5.6%) and 163 (0.8%) revisions within 90 days of surgery. Dislocation was the most common indication for readmission, and periprosthetic joint infection was the most common indication for revision. Early return to the OR was associated with a mean $105,988 (standard deviation [SD] = $76,865) in CMS claims for the inpatient stay. Factors associated with a higher risk of early reoperation were female sex, THA, longer length of stay, and discharge to long-term care facility. : This retrospective cohort study found that early return to the OR after TJA increased overall 90-day costs by 260%, suggesting that early reoperation might have a significant impact on bundled payments. Further study is warranted.
医疗保险和医疗补助服务中心（CMS）设立了全关节置换术（TJA）的捆绑支付方式，以便一次性向医疗机构支付手术费用及术后90天的费用。更好地了解哪些TJA患者有早期返回手术室（OR）的风险，对于术前优化那些存在可改变风险的患者至关重要，这可能会改善捆绑支付的效果。我们试图确定TJA患者早期返回手术室的最常见再入院原因、患者特征及费用。这是一项对2013年至2018年在一家三级护理医院接受初次全髋关节或膝关节置换术（THA或TKA）的医疗保险患者进行的回顾性队列研究。我们使用CMS研究可识别文件数据库来确定手术90天内再入院和翻修的最常见原因。总计费索赔用于确定早期再入院和翻修的费用。多变量回归分析用于确定与早期再入院或翻修相关的特征。在确定的20166例初次TJA患者中，我们发现1349例（5.6%）在术后90天内再入院，163例（0.8%）进行了翻修。脱位是再入院的最常见原因，假体周围关节感染是翻修的最常见原因。早期返回手术室与CMS住院索赔平均105,988美元（标准差[SD] = 76,865美元）相关。与早期再次手术风险较高相关的因素包括女性、THA、住院时间较长以及出院后入住长期护理机构。这项回顾性队列研究发现，TJA术后早期返回手术室使90天的总体费用增加了260%，这表明早期再次手术可能对捆绑支付有重大影响。有必要进行进一步研究。
