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.