Emergency Department Presentation Following Total Hip and Knee Arthroplasty: A Systematic Review

Abstract Background Recent changes to payment models for elective total joint arthroplasty (TJA) has led to increased interest in post-discharge healthcare utilization. While readmission has historically been of primary interest, emergency department (ED) presentation is increasingly a point of focus. The purpose of this review was to summarize the available literature pertaining to ED visits following total hip (THA) and knee (TKA) arthroplasty. Methods PubMed, MEDLINE, and Embase were searched. Clinical studies reporting rate, reasons and/or risk factors associated with ED presentation following TJA were included. Pooled returned to ED rates were calculated using weighted means. Results Twenty-seven studies (n = 1,484,043) were included. Following TJA, the mean 30- and 90-day rates of ED presentation were 8.1% and 10.3%, respectively. Rates were slightly higher in TKA versus THA patients at 30 (11.5% vs. 6.5%) and 90 days (10.8% vs. 9.7%). The most common reasons for ED presentation following TJA were pain (4.6-35%), medical concerns (5.6-24.5%) and swelling (1.4-17.5%). Studies analyzing the timing of ED visits found that most occurred within the first two-weeks post-discharge. Black race and Medicaid/Medicare insurance coverage were identified as risk factors associated with ED visits. Conclusion Emergency department visits present a high burden for the healthcare system, as upwards of 1 in 10 patients will return to the ED within 90 days of TJA. Future efforts should be made to develop cost-effective and patient-centered interventions that reduce preventable ED visits following TJA. As well, these rates should be taken into consideration when allocating resources for the care of TJA patients.