Scientific Articles   |    
Risk Factors for Readmission of Orthopaedic Surgical Patients
Elizabeth A. Dailey, MD1; Amy Cizik, MPH2; Jesse Kasten, MA, ATC3; Jens R. Chapman, MD2; Michael J. Lee, MD2
1 Department of Orthopaedics and Sports Medicine, University of Washington, 325 9th Ave. Box 359798, Seattle, WA 98104. E-mail address: ldailey@uw.edu
2 Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356500, Seattle, WA 98195
3 Fred Hutchinson Research Center, 825 Eastlake Avenue East, MS: LV-107, P.O. Box 19023, Seattle, WA 98109-1023
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at the University of Washington Medical Center, Seattle, Washington

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 05;95(11):1012-1019. doi: 10.2106/JBJS.K.01569
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Reducing hospital readmissions has become a priority in the development of policies aimed at patient safety and cost reduction. Evaluating the incidence of rehospitalization of orthopaedic surgical patients could help to identify targets for more efficient perioperative care. We addressed two questions: What is the incidence of thirty-day readmission for orthopaedic patients at an academic hospital? Can any risk factors for readmission be identified among rehospitalized patients?


This is a retrospective cohort study examining 3264 orthopaedic surgical admissions during two fiscal years from the hospital’s quality-improvement database. Cases of patients with unplanned readmission within thirty days were subjected to univariate and multivariate analysis to determine the odds ratio (OR) for readmission. Further descriptive analysis was performed with use of electronic medical record data from the cohort of readmitted patients.


The estimated cumulative incidence of unplanned thirty-day readmissions was 4.2% (i.e., 138 of the 3261 patients who were eligible for the study). Multivariate analysis indicated that marital status of “widowed” significantly increased the risk of readmission (OR, 1.846; 95% confidence interval [CI], 1.070 to 3.184; p = 0.03). Race significantly increased the odds of readmission in patients identified as African-American (OR, 2.178; 95% CI, 1.077 to 4.408; p = 0.03), or American Indian or Alaskan Native race (OR, 3.550; 95% CI, 1.429 to 8.815; p = 0.006). The risk of readmission was significant at p < 0.10 (OR 1.547; 95% CI, 0.941 to 2.545; p = 0.09) for patients with Medicaid insurance. Any intensive care unit stay gave the highest OR of readmission (OR, 2.356; 95% CI, 1.361 to 4.079; p = 0.002) for all demographic groups. Mean length of hospital stay was significantly longer, 5.9 days in the unplanned readmission group compared with 3.6 days for non-readmitted patients (OR, 1.038; 95% CI, 1.014 to 1.062; p = 0.002). Chart review of readmitted patients showed that 102 readmissions (73.9%) were classified as surgical; of these, thirty-five readmission events (34.3%) were for infection at the surgical site.


Longer length of hospital stay or admission to the intensive care unit significantly increased the likelihood of thirty-day readmission, regardless of demographics or discharge disposition. Marital status, Medicaid insurance status, and race may indicate how a patient’s social and economic resources can impact his or her risk of being readmitted to the hospital.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    WV - Charleston Area Medical Center
    OH - OhioHealth Research and Innovation Institute (OHRI)
    VA - OrthoVirginia