Thirty-Day Readmission Following Total Hip and Knee Arthroplasty – A Preliminary Single Institution Predictive Model

Mesko, Nathan W.; Bachmann, Keith R.; Kovacevic, David; LoGrasso, Mary E.; O’Rourke, Colin; Froimson, Mark I.

doi:10.1016/j.arth.2014.02.030

Cited by 102 publications

(55 citation statements)

References 37 publications

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“…Developing approaches that effectively reduce the risk of 30-day readmissions is important to maintain a viable healthcare environment that can sustain care to patients with government-based insurance plans, especially if potential consequences of increased readmission rates result in decreased funding to institutions that provide care disproportionately to patients at higher medical and non-medical risk for readmission [3]. While medical comorbidities are an important consideration in readmission risk, other factors may contribute substantially to individual patient risk for readmission including prolonged hospital LOS and discharges to skilled nursing facilities [11,12]. In this study, non-medical risk factors including CMS insurance program participation (Medicaid/Medicare) and discharge to either an inpatient rehabilitation or a skilled nursing facility were associated with higher rates of 30-day readmission.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding reasons for readmission may allow institutions to develop risk adjustment models for reducing readmission rates and for developing equations that accurately define risks, which may not be exclusively tied to medical diagnostic codes. While severity of medical illness contributes substantially to readmission risks, other factors including length of hospital stay and readmission into skilled nursing facilities have also been associated with increases in unplanned 30 and 90 day hospital readmission [11,12].…”

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confidence: 99%

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The Impact of Risk Reduction Initiatives on Readmission: THA and TKA Readmission Rates

Keeney

Nam

Johnson

et al. 2015

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Impact of Risk Reduction Initiatives on Readmission: THA and TKA Readmission Rates

Keeney

Nam

Johnson

et al. 2015

The Journal of Arthroplasty

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“…A higher ASA score predicted a longer LOS [26] , higher rate of readmission [23,25,29] , and complication rate [29] . A higher CCI score predicted higher rate of readmission [30] and a higher complication rate [31] . In the current study, the influence of preoperative variables appeared to be minimized as patients under went TJA in a PSH care model.…”

Section: Discussionmentioning

confidence: 99%

Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

Phan

Ahn

Rinehart

et al. 2016

WJO

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AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home (PSH) program. METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were preoperatively stratified based on specific procedure performed, age, gender, body mass index (BMI), American Society of Anesthesiologists Physical Classification System (ASA) score, and Charleston Comorbidity Index (CCI) score. The primary outcome criterion was hospital length of stay (LOS). Secondary criteria including operative room (OR) duration, trans- RESULTS:A total of 337 patients, 200 in the TKA cohort and 137 in the THA cohort, were eligible for the study. Nearly two-third of patients were female. Patient age averaged 64 years and preoperative BMI averaged 29 kg/m 2 . The majority of patients were ASA score Ⅲ and CCI score 0. After analysis, ASA score was the only variable predictive for LOS (P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d. ASA score was also the only variable predictive for readmission rate (P = 0.0332). BMI was the only variable predictive for PACU duration (P = 0.0136). Specific procedure performed, age, gender, and CCI score were not predictive for any of the outcome criteria. OR duration, transfusion rate, postoperative complications or discharge disposition were not significantly associated with any of the predictor variables. CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.

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“…LOS was longer for patients who received an allogeneic transfusion in our study, which was not influenced by adherence to the protocol. Inappropriate use of blood transfusions has been reported by others to occur 25% of the time causing an increase in LOS [9], cost [20], and patient transfer to inpatient facilities [20], not to mention other associated risks and complications of blood transfusions [3,4,10,12,14,15,18,19]. We expect that over time, by reducing transfusions in patients undergoing TJA, overall transfusionrelated complications would decrease without an increase in ischemic morbidity.…”

Section: Discussionmentioning

confidence: 99%

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

Markel

Allen

Zappa

2016

Clinical Orthopaedics &Amp; Related Research

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Background Standardized care plans are effective at controlling cost and quality. Registries provide insights into quality and outcomes for use of implants, but most registries do not combine implant and care quality data. In 2012, several Michigan area hospitals and a major insurance provider formed a voluntary statewide total joint database/registry, the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), to collect procedural, hospital, discharge, and readmission data. Noting substantial variation in transfusion practices after total joint arthroplasty (TJA) in our institutions, we used these prospectively collected data to examine whether awareness and education of the American Association of Blood Banks' (AABB) transfusion guidelines would result in decreased transfusions. Questions/purposes (1) Can an established arthroplasty registry help implement a quality initiative (QI) designed to decrease the proportion of transfused postoperative patients undergoing TJA? (2) Do data-driven transfusion protocols decrease length of stay without increasing ischemic complications (myocardial infarctions and cerebrovascular accidents)? (3) Are decreased transfusion proportions associated with decreased readmissions, nonischemic morbidity (including deep vein thrombosis and deep prosthetic infection), and mortality in postoperative patients who had undergone TJA? Methods After reviewing data from the recently established MARCQI registry, the orthopaedic department noticed many discrepancies and practice variances regarding blood transfusions among their providers. In October 2013, a QI was implemented to raise awareness of the discrepancies and education about the AABB guidelines was presented at the monthly orthopaedic service line meeting. A total of 1872 TJA cases were reviewed; 50 were excluded for incomplete data and two for intraoperative transfusions for the period before education (May 2012 to June 2013, n = 1240) and after education (November 2013 to April 2014, n = 580). Data collected included gender, age, length of stay, body mass index, preoperative hemoglobin level, lowest postoperative hemoglobin level during admission, transfusion status, number of units transfused, ischemic and nonischemic morbidity, hospital One or more of the authors (DCM), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA), Arboretum Ventures (Ann Arbor, MI, USA), Novi Bone and Joint (Novi, MI, USA), and CORE (Southfield, MI, USA). One or more of the authors (DCM) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Stryker and the Orthopaedic Research and Education Foundation (Rosemont, IL, USA) in the amount of USD 100,001 to USD 1,000,000. All ICMJE Conflict of Interest Forms for authors a...

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Thirty-Day Readmission Following Total Hip and Knee Arthroplasty – A Preliminary Single Institution Predictive Model

Cited by 102 publications

References 37 publications

The Impact of Risk Reduction Initiatives on Readmission: THA and TKA Readmission Rates

The Impact of Risk Reduction Initiatives on Readmission: THA and TKA Readmission Rates

Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

Can an Arthroplasty Registry Help Decrease Transfusions in Primary Total Joint Replacement? A Quality Initiative

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