Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that often leads to joint complications, requiring total hip or knee arthroplasty (THA/TKA). Patients with SLE are prone to postoperative complications, which increase the risk of unplanned readmissions and place a financial burden on hospitals due to penalties under Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program.

Objectives: This study assessed 30-day readmission rates, causes, and patient characteristics influencing readmissions in SLE patients after THA and TKA. The study aims to find factors which result in readmissions and ways to improve readmission rate as well as outcomes in SLE patient population.

Methods: We retrospectively examined the 2017-2020 Nationwide Readmission Database to identify yearly national readmission rates in SLE patients after THA/TKA, the reasons for 30-day readmission, and variables associated with the readmissions. Patients were Identified using ICD codes. We performed multivariable logistic regression models to identify factors associated with risk of readmission.

Results: The final cohort had 41,095 SLE patients underwent THA (19,631) or TKA (21,464). Medicare patients comprised the majority of the THA (70.9%) and TKA (74.8%) cohort. Readmission within 30 days occurred among 6.1% of THA patients and 4.8% of TKA patients. From 2017 to 2020, THA readmission rates increased from 6.5% to 9.2%. TKA readmissions stayed stable through the study period at 5.5%. Sepsis (14.6%), nonseptic infections (14.8%), cardiovascular (11.2%), and pulmonary complications (8.4%) were leading causes of readmission for THA patients, while sepsis (10.4%), joint/prosthetic infections (13.5%), and cardiovascular complications (8.2%) were the most common causes for TKA patients. Younger age, Charleson Comorbidity Index (CCI) score of ≥ 3, female sex, and length of stay (LOS) ≥ 3 days were significantly associated with higher odds of readmission for THA patients. Older age, CCI scores ≥3, and LOS ≥5 days were significantly associated with higher odds of readmission for TKA patients.

Conclusion: Our findings suggest that SLE patients undergoing THA and TKA have a high rate of readmission, with primary causes of readmission related to infections and multisystem organ complications. Younger age and higher CCI increased readmission risk indicating that preoperative planning and postoperative monitoring, especially for younger patients on Medicare, may help reduce readmissions and improve outcomes in this high-risk population.

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[2] Williams CL, Pujalte G, Li Z, Vomer RP, 2nd, Nishi M, Kieneker L, et al. Which Factors Predict 30-Day Readmission After Total Hip and Knee Replacement Surgery? Cureus. 2022 Mar;14(3):e23093. Epub 20220312.

[3] Ricciardi BF, Oi KK, Daines SB, Lee YY, Joseph AD, Westrich GH. Patient and Perioperative Variables Affecting 30-Day Readmission for Surgical Complications After Hip and Knee Arthroplasties: A Matched Cohort Study. J Arthroplasty. 2017 Apr;32(4):1074-9. Epub 20161021.

Acknowledgements: Bella Mehta is funded by the NIH NIAMS K23 career development award (1K23AR082991-01A1).

Disclosure of Interests: Omkar Anaspure: None declared, Michael Parks: None declared, David R. Fernandez: None declared, Jason Blevins Globus Medical, KCI, Lima Corporate, Chisa Hidaka: None declared, Susan M. Goodman Regenosine, UCB, Novartis, Bella Mehta Horizon advisory board.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.