Diabetes Increases Readmission Risk After Elective Total Joint Arthroplasty

Medicare beneficiaries undergoing elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) have increased odds of complications and hospital readmissions if they have diabetes, according to a study published online in The Journal of Bone & Joint Surgery. 

“Although this is, to our knowledge, the first study to examine complications and readmissions over a 90-day arthroplasty-related episode of care based on diabetes presence among Medicare beneficiaries, the findings paralleled the results of previous studies that examined similar outcomes under a 30-day episode of care,” researchers wrote. “These findings support that, while the Comprehensive Care for Joint Replacement (CJR) programs are showing promise to reduce costs, excluding certain comorbidities from cost adjustment is less appropriate for TKA and THA programs.” 

The findings stem from an investigation of 2013 and 2014 Medicare data for 521,230 beneficiaries with complications and 515,691 beneficiaries with readmissions within 90-day episodes of care for TKA or THA. Researchers used ICD-9 (International Classification of Diseases, 9th Revision) codes to determine whether beneficiaries had diabetes and, if so, its severity (controlled-uncomplicated diabetes, controlled-complicated diabetes, or uncontrolled diabetes). 

Patients with uncontrolled diabetes had the greatest odds for readmission (researchers reported an odds ratio of 1.48 compared with patients without diabetes) and complications (odds ratio 1.29) after TKA, according to the study. Patients with controlled-complicated diabetes had the greatest odds for readmission (odds ratio 1.70) and complications (odds ratio 1.45) after THA. 

For both TKA and THA, readmission odds were higher for Medicare beneficiaries with diabetes, regardless of severity, compared with Medicare beneficiaries without diabetes, researchers found. 

“Additional research is needed,” they advised, “to replicate our results and better understand how the level of diabetic control and severity are related to quality measures and performance-based outcomes in the CJR and other value-based payment programs associated with health-care reform.” 

—Jolynn Tumolo 

Reference: 

Na A, Middleton A, Haas A, Graham JE, Ottenbacher KJ. Impact of Diabetes on 90-Day Episodes of Care After Elective Total Joint Arthroplasty Among Medicare Beneficiaries [published online ahead of print, 2020 Oct 22]. J Bone Joint Surg Am. 2020;10.2106/JBJS.20.00203. doi:10.2106/JBJS.20.00203