No Evidence for Race and Socioeconomic Status as Independent Predictors of 30-Day Readmission Rates Following Orthopedic Surgery

Hunter, Tracey L.; Yoon, Richard S.; Hutzler, Lorraine; Band, Philip A.; Liublinksa, Victoria; Slover, James; Bosco, Joseph

doi:10.1177/1062860614534882

Cited by 10 publications

(9 citation statements)

References 19 publications

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“…Readmission in the immediate postoperative period may be more contingent on wound care and rehabilitation in our cohort, vs social determinants of health that may play a greater role after hospitalization for medical (ie, nonsurgical) reasons. 6,41 This concept is supported by a higher frequency of readmissions for cardiovascular complications among ADI4 patients in our study, but similar frequencies of readmission for stump complications and infection. In addition, 84% of patients in our study were discharged to a SNF/SAR, which may have mitigated the social challenges that lead to readmissions in other cohorts.…”

Section: Discussionsupporting

confidence: 77%

Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

Zhang¹,

Canner²,

Kayssi³

et al. 2021

Journal of Vascular Surgery

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Objective: Socioeconomic disadvantage is a known predictor of adverse outcomes and amputation in patients with diabetes. However, its association with outcomes after major amputation has not been described. Here, we aimed to determine the association of geographic socioeconomic disadvantage with 30-day readmission and 1-year reamputation rates among patients with diabetes undergoing major amputation.Methods: Patients from the Maryland Health Services Cost Review Commission Database who underwent major lower extremity amputation with a concurrent diagnosis of diabetes mellitus between 2015 and 2017 were stratified by socioeconomic disadvantage as determined by the area deprivation index (ADI) (ADI1 [least deprived] to ADI4 [most deprived]). The primary outcomes were rates of 30-day readmission and 1-year reamputation, evaluated using multivariable logistic regression models and Kaplan-Meier survival analyses.Results: A total of 910 patients were evaluated (66.0% male, 49.2% Black), including 30.9% ADI1 (least deprived), 28.6% ADI2, 19.1% ADI3, and 21.2% ADI4 (most deprived). After adjusting for differences in baseline demographic and clinical factors, the odds of 30-day readmission was similar among ADI groups (P > .05 for all). Independent predictors of 30-day readmission included female sex (odds ratio [OR], 1.45), Medicare insurance (vs private insurance; OR, 1.76), and peripheral artery disease (OR, 1.49) (P < .05 for all). The odds of 1-year reamputation was significantly greater among ADI4 (vs ADI1; OR, 1.74), those with a readmission for stump complication or infection/sepsis (OR, 2.65), and those with CHF (OR, 1.53) or PAD (OR, 1.59) (P < .05 for all).Conclusions: Geographic socioeconomic disadvantage is independently associated with 1-year reamputation, but not 30-day readmission, among Maryland patients undergoing a major amputation for diabetes. A directed approach at improving postoperative management of chronic disease progression in socioeconomically deprived patients may be beneficial to reducing long-term morbidity in this high-risk group.

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Section: Discussionsupporting

confidence: 77%

Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

Zhang¹,

Canner²,

Kayssi³

et al. 2021

Journal of Vascular Surgery

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“…36 Previous studies have shown mixed results regarding race as an independent predictor of 30-day readmission. 37,40,41 In our study, nonwhite race was a risk factor for readmission in the 30-day postoperative period. These higher rates of readmission may be secondary to less access to resources in both the institutions serving greater proportions of nonwhite patients as well as the patients themselves.…”

Section: Discussionmentioning

confidence: 53%

Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

Rezzadeh¹,

Behery²,

Kester³

et al. 2019

J Knee Surg

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There is a paucity of literature regarding the short-term readmission, reoperation, and complication rates of patellofemoral arthroplasty (PFA). The purpose of this study is to determine the incidence and risk factors of 30-day postoperative complications in patients undergoing PFA. A retrospective cohort study of subjects who underwent PFA from 2010 to 2015 was performed using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Perioperative outcomes and 30-day postoperative complications were ascertained, and patient demographics and comorbidities were analyzed using linear and binomial logistic regression analyses to determine risk factors for postoperative complications. Among the 1,069 patients identified in the NSQIP database, there was a 30-day readmission rate of 4.3% and a 30-day reoperation rate of 1.5%. The leading complications identified were bleeding requiring transfusion (11.7%), urinary tract infection (0.8%), and deep vein thrombosis (DVT) (0.8%). Younger age was a risk factor for superficial wound infection (p = 0.012). Older age was a significant risk factor for longer hospital stays, readmission, bleeding requiring transfusion, urinary tract infection, and pneumonia (p < 0.05 for all). Male sex was a risk factor for longer operation time and DVT (p = 0.001 and p = 0.017, respectively), while female sex was associated with greater incidence of bleeding requiring transfusion (p = 0.049). Elevated body mass index (BMI) was a risk factor for longer hospital stays, greater total operation time, and bleeding requiring transfusion (p < 0.001, p < 0.001, and p = 0.001, respectively). Nonwhite race was a significant risk factor for readmission (p = 0.008). This represents the largest study on early readmissions and the associated risk factors after PFA. PFA 30-day readmission and reoperation rates were <5%. Older age and elevated BMI were both identified as risk factors for adverse perioperative outcomes, including longer operation times, longer hospital stays, and bleeding requiring transfusion.

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“…For example, according to the 2018 5-Year American Community Survey 46 , in the area immediately surrounding our hospital, the median household income was $64,524, but the median income was $103,340 for a White householder and $32,707 for a Black/African American householder. Therefore, the use of median household income may discount the true economic inequality that a patient faces within a neighborhood 45,47,48 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the prominent associations between low-income patients and increased rates of hospital readmission reported in nonoperative cohorts 40-43 and surgical cohorts 44,45 , however, one shortcoming in the literature is the use of median household income by area as a proxy for economic standing. This metric does not consider race and sex differences in household income by area and does not correct for the number of persons contributing to the household income 40-43 .…”

Section: Discussionmentioning

confidence: 99%

The Impact of Social Determinants of Health on 30 and 90-Day Readmission Rates After Spine Surgery

Mohanty

Lad

Casper

et al. 2022

Journal of Bone and Joint Surgery

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Background:Since its 2012 inception, the U.S. Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) has espoused cost-effective health-care delivery by financially penalizing hospitals with excessive 30-day readmission rates. In this study, we hypothesized that socioeconomic factors impact readmission rates of patients undergoing spine surgery.Methods:In this study, 2,830 patients who underwent a spine surgical procedure between 2012 and 2018 were identified retrospectively from our institutional database, with readmission (postoperative day [POD] 0 to 30 and POD 31 to 90) as the outcome of interest. Patients were linked to U.S. Census Tracts and ZIP codes using the Geographic Information Systems (ArcGIS) mapping program. Social determinants of health (SDOH) were obtained from publicly available databases. Patient income was estimated at the Public Use Microdata Area level based on U.S. Census Bureau American Community Survey data. Univariate and multivariable stepwise regression analyses were conducted. Significance was defined as p < 0.05, with Bonferroni corrections as appropriate.Results:Race had a significant effect on readmission only among patients whose estimated incomes were <$31,650 (χ2 = 13.4, p < 0.001). Based on a multivariable stepwise regression, patients with estimated incomes of <$31,000 experienced greater odds of readmission by POD 30 compared with patients with incomes of >$62,000; the odds ratio (OR) was 11.06 (95% confidence interval [CI], 6.35 to 15.57). There were higher odds of 30-day readmission for patients living in neighborhoods with higher diabetes prevalence (OR, 3.02 [95% CI, 1.60 to 5.49]) and patients living in neighborhoods with limited access to primary care providers (OR, 1.39 [95% CI, 1.10 to 1.70]). Lastly, each decile increase in the Area Deprivation Index of a patient’s Census Tract was associated with higher odds of 30-day readmission (OR, 1.40 [95% CI, 1.30 to 1.51]).Conclusions:Socioeconomically disadvantaged patients and patients from areas of high social deprivation have a higher risk of readmission following a spine surgical procedure.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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No Evidence for Race and Socioeconomic Status as Independent Predictors of 30-Day Readmission Rates Following Orthopedic Surgery

Cited by 10 publications

References 19 publications

Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

Geographical socioeconomic disadvantage is associated with adverse outcomes following major amputation in diabetic patients

Patellofemoral Arthroplasty: Short-Term Complications and Risk Factors

The Impact of Social Determinants of Health on 30 and 90-Day Readmission Rates After Spine Surgery

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