Prediction models of Medicare 90-day postdischarge deaths, readmissions, and costs in bowel operations

Fry, Donald E.; Pine, Michael; Locke, David; Pine, Gregory

doi:10.1016/j.amjsurg.2014.12.005

Cited by 22 publications

(19 citation statements)

References 10 publications

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“…Exploratory outcomes included prolonged length of stay (a surrogate for postoperative complications) and time to revision surgery among patients undergoing primary knee or hip arthroplasty. Prolonged length of stay was defined as length of stay >90th percentile (empirically derived in the data as >5 days for revision surgeries and >4 days for primary surgeries) . We also examined wound complications and rates of specific postoperative infections, including pneumonia, septicemia/bacteremia, and urinary infection (see Supplementary Table , available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr.23843/abstract).…”

Section: Methodsmentioning

confidence: 99%

Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes

George

Baker

Winthrop

et al. 2019

Arthritis Care & Research

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Objective. Guidelines recommend withholding biologic therapies before hip and knee arthroplasty, yet evidence to inform optimal timing is limited. The aim of this study was to determine whether withholding abatacept infusions is associated with lower risk of adverse postoperative outcomes.Methods. This retrospective cohort study, which used US Medicare and Truven MarketScan administrative data from January 2006 to September 2015, evaluated adults with rheumatoid arthritis who received intravenous abatac ept (precisely dated in claims data) within 6 months of elective primary or revision hip or knee arthroplasty. Propensity weighted analyses using inverse probability weights compared the risk of 30-day hospitalized infection and 1-year prosthetic joint infection (PJI) between patients with different abatacept stop timing (time between last infusion and surgery). Secondary analyses evaluated nonurinary hospitalized infections and 30-day readmissions.Results. After 1,939 surgeries among 1,780 patients, there were 175 hospitalized infections (9.0%), 115 nonurinary hospitalized infections (5.9%), 39 PJIs (2.4/100 person-years), and 114/1,815 30-day readmissions (6.3%). There were no significant differences in outcomes with abatacept stop timing <4 weeks (1 dosing interval) versus 4-8 weeks (hospitalized infection odds ratio [OR] 0.93 [95% confidence interval (95% CI) 0.65-1.34]; nonurinary hospitalized infection OR 0.93 [95% CI 0.60-1.44]; PJI hazard ratio 1.29 [95% CI 0.62-2.69]; 30-day readmission OR 1.00 [95% CI 0.65-1.54]). Similarly, there were no significant differences in outcomes with abatacept stop timing <4 weeks versus ≥8 weeks. Glucocorticoid use >7.5 mg/day was associated with greater risk of hospitalized infection (OR 2.19 [95% CI 1.28-3.77]) and nonurinary hospitalized infection (OR 2.38 [95% CI 1.22-4.64]).Conclusion. Compared to continuing intravenous abatacept, withholding abatacept for ≥4 weeks (one dosing interval) before surgery was not associated with a lower risk of hospitalized infection, nonurinary hospitalized infection, PJI, or 30-day readmission.

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Section: Methodsmentioning

confidence: 99%

Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes

George

Baker

Winthrop

et al. 2019

Arthritis Care & Research

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“…Secondary outcomes included prolonged length of stay as a proxy for postoperative complications (defined as >5 days, the 90th percentile of length of stay) , and surgical‐site infection within 90 days of surgery, based on the presence of any of 4 previously used diagnosis codes from inpatient discharge diagnoses (see Supplementary Table , available on the Arthritis Care & Research web site at http://onlinelibrary.wiley.com/doi/10.1002/acr.23209/abstract) .…”

Section: Methodsmentioning

confidence: 99%

Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty

George

Baker

Hsu

et al. 2017

Arthritis Care & Research

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Objective The optimal timing of TNF antagonists before elective surgery is unknown. This study evaluated the association between infliximab timing and serious infection after elective hip or knee arthroplasty. Methods A retrospective cohort study evaluated U.S. Medicare patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received infliximab within 6 months of elective knee or hip arthroplasty from 2007–2013. Propensity adjusted analyses examined whether infliximab stop timing (time between most recent infusion and surgery) was associated with hospitalized infection within 30 days or prosthetic joint infection (PJI) within 1 year. Results Hospitalized infection within 30 days occurred after 270/4288 (6.3%) surgeries. Infliximab stop timing < 4 weeks vs 8–12 weeks was not associated with an increase in infection within 30 days: propensity adjusted OR 0.90 (95% CI 0.60, 1.34). The rate of PJI was 2.9 per 100 person-years and was not increased in patients with stop timing < 4 weeks vs 8–12 weeks: HR 0.98 (95% CI 0.52, 1.87). Glucocorticoid dose > 10mg/day was associated with increased risk of 30-day infection (OR 2.11, 95% CI 1.30, 3.40) and PJI (HR 2.70, 95% CI 1.30, 5.60). Other risk factors for infection included elderly age, comorbidities, revision surgery, and previous hospitalized infection. Conclusion Administering infliximab within 4 weeks of elective knee or hip arthroplasty was not associated with a higher risk of short or long-term serious infection compared to withholding infliximab for longer time periods. Glucocorticoid use, especially > 10mg/day, was associated with an increased infection risk.

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“…As the period of data collected was relating to procedures in a two week window, variability may ultimately be related to statistical variation rather than poor performance or other unknown factors. Previous studies have focussed heavily on patient factors associated with readmission, generating models and risk scores to identify those at risk [19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Readmissions after general surgery: a prospective multicenter audit

Lee

Daniels

Wild

et al. 2017

Journal of Surgical Research

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Prediction models of Medicare 90-day postdischarge deaths, readmissions, and costs in bowel operations

Cited by 22 publications

References 10 publications

Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes

Timing of Abatacept Before Elective Arthroplasty and Risk of Postoperative Outcomes

Perioperative Timing of Infliximab and the Risk of Serious Infection After Elective Hip and Knee Arthroplasty

Readmissions after general surgery: a prospective multicenter audit

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