Meloxicam is associated with Lower Hospital Readmission Rates for Hip and Knee Replacement Patients at Virtua Voorhees Hospital based on Real World Evidence Study of Medicare Claims Data

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In Meloxicam, Major Joint Replacement

By: Sara Riascos  Apr. 01, 2022

Background:

Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Meloxicam is a nonsteroidal anti-inflammatory drug. Studies show that the early use of Meloxicam attenuates postoperative pain and improves patient satisfaction when used after a TKA.

Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Meloxicam within 7 days of hospitalization was associated with lower hospital readmission rates for Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) Patients at Virtua Voorhees Hospital in Voorhees, New Jersey. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real-World Evidence from Medicare Claims data, for hospitalizations at Virtua Voorhees Hospital between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) patients who dispensed Meloxicam within 7 Days of Hospitalization using Part D drugs claims database
   2. Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) patients who did not dispense Meloxicam within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Meloxicam was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Virtua Voorhees Hospital. For patients whose primary DRG Diagnosis was “Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC)”(470) and when Meloxicam was used within 7 days of hospitalization, the readmission rate was 6% compared to the cohort where Meloxicam was not used, whose readmission rate was 8%. The readmission odds ratio for these cohorts was 0.72. The use of Meloxicam was associated with a 28% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Meloxicam at Virtua Voorhees Hospital is shown below.

Primary DRG Diagnosis Code	Primary DRG Diagnosis Code Description	Total Hospitalizations without Meloxicam	Readmission Without Meloxicam	Readmission Rate without Meloxicam	Total Hospitalizations with Meloxicam	Readmission with Meloxicam	Readmission Rate with Meloxicam	Readmission Odds Ratio	Reduction in Readmission with Meloxicam (%)	Confidence Interval (-)	Confidence Intervals (+)
470	Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC)	2,638

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) were not prescribed Meloxicam within 7 days of discharge.

DRG CODE	Hospital	Hospitalizations with Major Joint Replacement	% of Hospitalizations without Meloxicam
470	HSS	11,680	99.63%
	Virtua Voorhees Hospital	2,652	99.47%
	Harrisburg Hospital	2,420	99.46%

​Hospitalizations with Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) = Above Listed DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Meloxicam within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) patients at Virtua Voorhees Hospital. This analysis shows that a significant number of Patients are not dispensed Meloxicam after Major Joint Replacement Or Reattachment Of Lower Extremity Without Major Complication Or Comorbidity (MCC) hospitalizations at Virtua Voorhees Hospital or major US Hospitals.