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Orthopedic Surgery

Training Level

Resident PGY 5


Henry Ford Hospital


Background: Bundled care payment models, such as the Comprehensive Care for Joint Replacement Model, developed by Centers for Medicare and Medicaid Services, aim to improve the quality of joint replacement. Metrics, including emergency room visit rates after Primary Total Knee and Total Hip Arthroplasty (TKA and THA) are of particular interest. The purpose of this study was to determine if pre-operative Emergency Department (ED) visits are predictive of post-operative ED visits among patients undergoing elective THA or TKA.

Methods: In a retrospective analysis of 6996 patients who underwent elective primary hip or knee arthroplasty (2453 hip, 4543 knee) we identified all patients who had an ED visit from up to one year prior to their surgical date to 90 days after. We assessed if preoperative visit frequency or temporality are predictive of a return ED visit within 90 days. Billable charges of each ED visit were recorded as a secondary measure.

Results: TKA and THA patients with a single preoperative ED visit had an odds ratio (OR) of 1.9 and 2.0, respectively, of returning to the ER postoperatively (P<.001). Increasing preoperative visit frequency correlated with increasing odds ratios (OR 1.9 - 16.7,P<.001). The proximity of the most recent preoperative visit prior to surgery had a positive trend towards a larger effect, but did not clearly demonstrate a dose-dependent effect. The average billable charges per postoperative ED visit were approximately $10,000.

Conclusions: Presentation to the ED is common prior to total joint arthroplasty and is predictive of a postoperative visit within 90 days. Increasing preoperative visit frequency further increases a patients’ risk of a postoperative visit within 90 days. Interventions aimed at reducing the frequency of postoperative ED visits, particularly in at risk patients, may provide value to overall joint replacement care.

Presentation Date


Emergency Department Visit Within One Year Prior to Elective Total Hip Arthroplasty is Predictive of Post-Operative Return to Emergency Department within 90 Days