What question did this study set out to answer?

This research aims to identify factors influencing ninety day readmission rates following elective primary total knee arthroplasty.

March 28, 2026Open Access

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Determinants of Ninety Day Readmission After Elective Primary Total Knee Arthroplasty: A Nationwide Readmissions Database Study of 437,121 Cases

DMDavid MamanTechnion – Israel Institute of Technology YSYaniv SteinfeldTechnion – Israel Institute of Technology YBYaron BerkovichTechnion – Israel Institute of Technology

Key Points

This research aims to identify factors influencing ninety day readmission rates following elective primary total knee arthroplasty.
Analyzed data from the Nationwide Readmissions Database for 2020 to 2022.
Included adult patients undergoing elective primary TKA with complete ninety day follow up.
Excluded revision, bilateral, nonelective, and certain complications.
Used multivariable logistic regression to identify independent predictors of readmission.
Identified 437,121 elective primary TKAs with a mean patient age of 67.6 years.
Reported a ninety day readmission rate of 5.3 percent.
Common causes of readmission included periprosthetic infection, gastrointestinal disorders, and cardiac events.
Age, type 2 diabetes, and chronic lung disease were identified as independent predictors of readmission.
Robotically assisted and navigation guided procedures were associated with lower odds of readmission.

Abstract

Ninety day readmission after total knee arthroplasty (TKA) is a key quality and cost metric in value based care. Recent work in Arthroplasty Today has highlighted the role of mental health and machine learning based prediction, but contemporary national data focusing exclusively on elective primary TKA with full ninety day follow up remain limited. We analyzed the Nationwide Readmissions Database for 2020 to 2022. Adult patients undergoing elective primary TKA with surgery on the calendar day of admission were included. Revision, bilateral, nonelective, fracture, malignancy, infection, and COVID 19 related cases were excluded. Only discharges from January through September were used to ensure complete ninety day follow up. The primary outcome was ninety day all cause readmission. Multivariable logistic regression identified independent predictors. We identified 437,121 elective primary TKAs. Mean age was 67.6 ± 9.5 years and 61.2 percent were women. Robotic assisted TKA accounted for 9.9 percent and navigation guided TKA for 6.0 percent of procedures. The ninety day readmission rate was 5.3 percent. Periprosthetic infection (12.6 percent), gastrointestinal disorders (12.3 percent), cellulitis and soft tissue infection (11.5 percent), respiratory issues (11.0 percent), and cardiac events (9.8 percent) were the most common causes. Independent predictors included age, type 2 diabetes, chronic kidney disease, chronic lung disease, heart failure, prior stroke, prior myocardial infarction, peripheral vascular disease, fibromyalgia, and blood loss anemia during index admission. Female sex, obesity, dyslipidemia, robotic assistance, and navigation guidance were associated with lower odds of readmission. Ninety day readmission after elective primary TKA is infrequent but driven by a mixture of orthopedic and systemic medical complications. High risk comorbidity clusters and perioperative blood loss anemia are important targets for optimization. Computer assisted techniques showed a modest protective association. Level III

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Cite This Study

Maman et al. (Sun,) studied this question.

synapsesocial.com/papers/69c772158bbfbc51511e2511 https://doi.org/https://doi.org/10.1016/j.jorep.2026.100966

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