Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis

Abstract

Background: The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue. Methods: Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale (NOS). Results: Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class (OR, 1.502; 95%CI:1.405–1.605; P < .001), heart failure (OR,1.494; 95%CI: 1.235–1.754; P < .001), diabetes (OR, 1.246; 95%CI:1.128–1.377; P < .001), liver disease (OR, 1.339; 95%CI:1.237–1.450; P < .001), drinking (OR, 1.114; 95%CI:1.041–1.192; P = .002), depression (OR, 1.294; 95%CI:1.223–1.396; P < .001), urinary tract infection (OR, 5.879; 95%CI: 5.119–6.753; P < .001), and deep vein thrombosis (OR, 10.007; 95%CI: 8.787–11.396; P < .001) showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk. Conclusion: The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.