Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement

Background Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient’s postdischarge experience. Methods We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. Results The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital’s risk-standardized ED visit rate did not correlate with its readmission rate (r = −0.03, P = .50). If ED visits were included in a broader “readmission” measure, 246 (47.6%) hospitals would change perceived performance groups. Conclusion Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization