Emergency Department Visits After Total Joint Arthroplasty in a Closed Urban Setting: A Report of 1,000 Consecutive Cases.

Background: Rates of emergency department (ED) visits and readmissions after total joint arthroplasty (TJA) have been cited as indicators of TJA quality. Understanding the incidence and nature of these events is critical for prevention. The purpose of this study was to analyze readmission rates 30 and 90 days after TJA at a safety-net hospital in an urban setting and to compare this readmission rate with that for non-safety-net hospitals found in the current literature. In addition, we aimed to quantify the readmissions in our safety-net hospital that led to future complications. This would help us identify if there is a high incidence of preventable readmission rates in this unique socioeconomic environment.

Methods: Using our institutional electronic medical record system, we retrospectively studied 1000 consecutive TJA encounters between 2014 and 2019 to determine the rates of treat-and-release ED visits within 30 and 90 days after surgery. The ED charts were reviewed, and patients who returned to the operating room (OR) for a TJA complication within 1 year of surgery were identified. We compared the OR return rates of people who had ED visits with those in the control group.

Results: A total of 110 (11%) and 191 (19.1%) patients visited the ED within 30 and 90 days of surgery, respectively. Fisher exact test confirmed that having an ED visit within 90 days of TJA because of lower extremity pain and/or swelling or a social issue was associated with returning to the OR within a year of TJA. Having an ED visit within 30 or 90 days of total hip replacement was associated with returning to the OR for total hip replacement complications.

Conclusion: ED visits after TJA at an urban safety-net hospital were markedly higher than those reported in the literature for nonurban safety-net hospitals. In addition, postoperative ED visits for specific diagnoses may predict complications. This indication may have implications for a risk adjustment in programs such as bundled payments. Our results also indicate overutilization of the ED by avoidable ED visits. This represents a call for alternatives to the ED for patients after TJA in environments served by safety-net hospitals.