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Kundana PK, Agrawal M, Tullu MS, Kulkarni AA. Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital. Indian J Med Res 2023; 157:74-80. [PMID: 37040230 PMCID: PMC10284360 DOI: 10.4103/ijmr.ijmr_1731_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Indexed: 04/04/2023] Open
Abstract
Background & objectives Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.
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Affiliation(s)
- P. Keerthi Kundana
- Department of Pediatrics, Seth G.S. Medical College & The King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukesh Agrawal
- Department of Pediatrics, Seth G.S. Medical College & The King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Milind S. Tullu
- Department of Pediatrics, Seth G.S. Medical College & The King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Ankita A. Kulkarni
- Department of Pediatrics, Seth G.S. Medical College & The King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Patel V, Metz A, Schultz L, Nerenz D, Park P, Chang V, Schwalb J, Khalil J, Perez-Cruet M, Aleem I. Rates and reasons for reoperation within 30 and 90 days following cervical spine surgery: a retrospective cohort analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Spine J 2023; 23:116-123. [PMID: 36152774 DOI: 10.1016/j.spinee.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/16/2022] [Accepted: 09/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Reoperation following cervical spinal surgery negatively impacts patient outcomes and increases health care system burden. To date, most studies have evaluated reoperations within 30 days after spine surgery and have been limited in scope and focus. Evaluation within the 90-day period, however, allows a more comprehensive assessment of factors associated with reoperation. PURPOSE The purpose of this study is to assess the rates and reasons for reoperations after cervical spine surgery within 30 and 90 days. DESIGN We performed a retrospective analysis of a state-wide prospective, multi-center, spine-specific database of patients surgically treated for degenerative disease. PATIENT SAMPLE Patients 18 years of age or older who underwent cervical spine surgery for degenerative pathologies from February 2014 to May 2019. Operative criteria included all degenerative cervical spine procedures, including those with cervical fusions with contiguous extension down to T3. OUTCOME MEASURES We determined causes for reoperation and independent surgical and demographic risk factors impacting reoperation. METHODS Patient-specific and surgery-specific data was extracted from the registry using ICD-10-DM codes. Reoperations data was obtained through abstraction of medical records through 90 days. Univariate analysis was done using chi-square tests for categorical variables, t-tests for normally distributed variables, and Wilcoxon rank-sum tests for variables with skewed distributions. Odds ratios for return to the operating room (OR) were evaluated in multivariate analysis. RESULTS A total of 13,435 and 13,440 patients underwent cervical spine surgery and were included in the 30 and 90-day analysis, respectively. The overall reoperation rate was 1.24% and 3.30% within 30 and 90 days, respectively. Multivariate analysis showed within 30 days, procedures involving four or more levels, posterior only approach, and longer length of stay had increased odds of returning to the OR (p<.05), whereas private insurance had a decreased odds of return to OR (p<.05). Within 90 days, male sex, coronary artery disease (CAD), previous spine surgery, procedures with 4 or more levels, and longer length of stay had significantly increased odds of returning to the OR (p<.05). Non-white race, independent ambulatory status pre-operatively, and having private insurance had decreased odds of return to the OR (p<.05). The most common specified reasons for return to the OR within 30 days was hematoma (19%), infection (17%), and wound dehiscence (11%). Within 90 days, reoperation reasons were pain (10%), infection (9%), and hematoma (8%). CONCLUSION Reoperation rates after elective cervical spine surgery are 1.24% and 3.30% within 30 and 90 days, respectively. Within 30 days, four or more levels, posterior approach, and longer length of stay were risk factors for reoperation. Within 90 days, male sex, CAD, four or more levels, and longer length of hospital stay were risk factors for reoperation. Non-white demographic and independent preoperative ambulatory status were associated with decreased reoperation rates.
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Affiliation(s)
- Vandan Patel
- University of Michigan Department of Orthopedic Surgery
| | - Allan Metz
- University of Michigan Department of Orthopedic Surgery
| | | | | | - Paul Park
- University of Michigan Department of Neurosurgery
| | | | | | | | | | - Ilyas Aleem
- University of Michigan Department of Orthopedic Surgery.
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Lee NJ, Lenke LG, Cerpa M, Lombardi J, Ha A, Park P, Leung E, Sardar ZM, Lehman RA. The 90-Day Reoperations and Readmissions in Complex Adult Spinal Deformity Surgery. Global Spine J 2022; 12:415-422. [PMID: 32878483 PMCID: PMC9121151 DOI: 10.1177/2192568220953391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Identify surgical complex adult spine deformity patients who are at increased risk for an unplanned postoperative 90-day readmission and/or reoperation. METHODS A total of 227 consecutive records of complex adult (≥18 years old) spine deformity surgeries from 2015 to 2018 were reviewed. Demographics, comorbidities, operative details, and postoperative complication data was collected. Chi-square/Fisher's exact test and t tests were used for bivariate analysis. To determine independent predictors for readmissions/reoperations, stepwise multivariate logistic regressions were employed. The C-statistic and Hosmer-Lemeshow (HL) value was used to measure concordance and goodness of fit. RESULTS Average age was 50.5 ± 17.8 years and 67.8% were female. Ninety-day readmission and reoperation rates were 7.0% and 5.3%, respectively. Median number of days after index discharge date resulting in readmission and reoperation were 16.5 and 28, respectively. The multivariate regression for 90-day readmissions included pulmonary comorbidity, depression, history of deep vein thrombosis/pulmonary embolism (DVT/PE), and gastrointestinal comorbidity (C-statistic = 0.82; HL = 0.79). Pulmonary comorbidity, depression, and history of DVT/PE increased risk for 90-day readmission by 5-, 3.5-, and 10.2-fold, respectively. The multivariate regression for 90-day reoperations was similar to readmissions (C-statistic = 0.89; HL = 0.31). Operative time>7 hours and history of DVT/PE increased risk for early reoperation by 5.8- and 8.7-fold, respectively. CONCLUSIONS An emphasis on medically optimizing patients with preexisting pulmonary comorbidities, depression, and history of DVT/PE may have a substantial impact on improving short-term outcomes in this population. The present study provides benchmark data and may serve as an initial model to predict unplanned reoperations and readmissions.
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Affiliation(s)
- Nathan J. Lee
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Lawrence G. Lenke
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Meghan Cerpa
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA,Meghan Cerpa, Columbia University Medical Center, 5141 Broadway, New York, NY 10034, USA.
| | - Joseph Lombardi
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Alex Ha
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Paul Park
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Eric Leung
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Zeeshan M. Sardar
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
| | - Ronald A. Lehman
- Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY, USA
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Fésüs A, Benkő R, Matuz M, Kungler-Gorácz O, Fésüs MÁ, Bazsó T, Csernátony Z, Kardos G. The Effect of Pharmacist-Led Intervention on Surgical Antibacterial Prophylaxis (SAP) at an Orthopedic Unit. Antibiotics (Basel) 2021; 10:antibiotics10121509. [PMID: 34943721 PMCID: PMC8698705 DOI: 10.3390/antibiotics10121509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Perioperative antibiotic use is a common reason for antibiotic misuse. Evidence suggests that adherence to SAP guidelines may improve outcomes. The purpose of this study was to analyze the impact of pharmacist-led antibiotic stewardship interventions on SAP guideline compliance. The study was conducted at an Orthopedic Department of a tertiary care medical center. SAP compliance and antibiotic exposure in the pre-intervention and intervention period was compared using chi-square, Fisher exact, and Mann-Whitney tests, as appropriate. Prophylactic antibiotic use in orthopedic joint arthroplasties (overall guideline adherence: agent, dose, frequency, duration), clinical outcomes (length of stay-LOS, number of surgical site infections-SSIs), antibiotic exposure and direct antibiotic costs were compared between pre-intervention and intervention periods. Significant improvement in mean SAP duration (by 42.9%, 4.08 ± 2.08 vs. 2.08 ± 1.90 days, p ˂ 0.001), and overall guideline adherence regarding antibiotic use (by 56.2%, from 2% to 58.2%, p ˂ 0.001) were observed. A significant decrease was observed in antibiotic exposure in SAP (by 41%, from 6.07 ± 0.05 to 3.58 ± 4.33 DDD/patient, p ˂ 0.001), average prophylactic antibiotic cost (by 54.8%, 9278.79 ± 6094.29 vs. 3598.16 ± 3354.55 HUF/patient), and mean LOS (by 37.2%, from 11.22 ± 6.96 to 7.62 ± 3.02 days, p < 0.001); and a slight decrease in the number of confirmed SSIs was found between the two periods (by 1.8%, from 3% to 1.2%, p = 0.21). Continuous presence of the clinical pharmacist led to significant improvement in SAP guideline adherence, which was accompanied by decreased antibiotic exposure and cost.
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Affiliation(s)
- Adina Fésüs
- Central Clinical Pharmacy, Clinical Center, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (O.K.-G.)
- Department of Pharmacodynamics, Faculty of Pharmacy, University of Debrecen, H-4032 Debrecen, Hungary
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, H-4032 Debrecen, Hungary
| | - Ria Benkő
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Mária Matuz
- Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary; (R.B.); (M.M.)
- Central Pharmacy, Albert Szent Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
| | - Orsolya Kungler-Gorácz
- Central Clinical Pharmacy, Clinical Center, University of Debrecen, H-4032 Debrecen, Hungary; (A.F.); (O.K.-G.)
- Doctoral School of Pharmaceutical Sciences, University of Debrecen, H-4032 Debrecen, Hungary
- Department of Metagenomics, University of Debrecen, H-4032 Debrecen, Hungary
| | - Márton Á. Fésüs
- Department of Traumatology and Hand Surgery, Faculty of Medicine, University of Debrecen, H-4031 Debrecen, Hungary;
| | - Tamás Bazsó
- Department of Orthopedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (T.B.); (Z.C.)
| | - Zoltán Csernátony
- Department of Orthopedic Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary; (T.B.); (Z.C.)
| | - Gábor Kardos
- Department of Metagenomics, University of Debrecen, H-4032 Debrecen, Hungary
- Correspondence:
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Dimentberg R, Caplan IF, Winter E, Glauser G, Goodrich S, McClintock SD, Hume EL, Malhotra NR. Prediction of Adverse Outcomes Within 90 Days of Surgery in a Heterogeneous Orthopedic Surgery Population. J Healthc Qual 2021; 43:e53-e63. [PMID: 32773485 DOI: 10.1097/jhq.0000000000000280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The LACE+ index has been shown to predict readmissions; however, LACE+ has not been validated for extended postoperative outcomes in an orthopedic surgery population. The purpose of this study is to examine whether LACE+ scores predict unplanned readmissions and adverse outcomes following orthopedic surgery. Use of the LACE1 index to proactively identify at-risk patients may enable actions to reduce preventable readmissions. METHODS LACE+ scores were retrospectively calculated at the time of discharge for all consecutive orthopedic surgery patients (n = 18,893) at a multicenter health system over 3 years (2016-2018). Coarsened exact matching was used to match patients based on characteristics not assessed in the LACE+ index. Outcome differences between matched patients in different LACE quartiles (i.e. Q4 vs. Q3, Q2, and Q1) were analyzed. RESULTS Higher LACE+ scores significantly predicted readmission and emergency department visits within 90 days of discharge and for 30-90 days after discharge for all studied quartiles. Higher LACE+ scores also significantly predicted reoperations, but only between Q4 and Q3 quartiles. CONCLUSIONS The results suggest that the LACE+ risk-prediction tool may accurately predict patients with a high likelihood of adverse outcomes after a broad array of orthopedic procedures.
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Batko BD, Hreha J, Potter JS, Guinand L, Reilly MC, Sirkin MS, Vosbikian MM, Adams MR. Orthopaedic trauma during COVID-19: Is patient care compromised during a pandemic? J Clin Orthop Trauma 2021; 18:181-186. [PMID: 33967549 PMCID: PMC8088543 DOI: 10.1016/j.jcot.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Coronavirus disease-2019 (COVID-19) placed unprecedented pressure on the healthcare system. Many institutions implemented a government-mandated restructured set of safety and administrative protocols to treat urgent orthopaedic trauma patients. The objective of this study was to compare two cohorts of patients, a COVID group and non-COVID control group, and to evaluate the effectiveness of safety measures outlined in the Rutgers Orthopaedic Trauma Patient Safety Protocol (ROTPSP). Secondary outcomes were to elucidate risk factors for complications associated with fractures and COVID-19. METHODS Patients treated for orthopaedic traumatic injuries were retrospectively identified between March and May 2020, and compared to a series of patients from the same time period in 2018. Main outcome measures included surgical site infections (SSI), length of stay (LOS), post-operative LOS (poLOS), presentation to OR time (PORT), and length of surgery. RESULTS After review, 349 patients (201 non-COVID, 148 COVID) undergoing 426 surgeries were included. Average LOS (11.91 days vs. 9.27 days, p = 0.04), poLOS (9.68 days vs. 7.39 days, p = 0.03), and PORT (30.56 vs. 25.59 h, p < 0.01) was significantly shorter in the COVID cohort. There were less SSI in the COVID group (5) compared to the non-COVID group (14) (p = 0.03). Overall complications were significantly lower in the COVID group. Patients receiving Cepheid tests had significantly shorter LOS and poLOS compared to patients receiving the RNA and DiaSorin tests (p < 0.01 and p < 0.01, respectively). The Cepheid test carried the best benefit-to-cost ratio, 0.10, p < 0.05. CONCLUSION The restructuring of care protocols caused by COVID-19 did not negatively impact perioperative complication rates, PORT or LOS. Cepheid COVID test type administered upon admission plays an integral role in a patient's hospital course by reducing both length of stay and hospital costs. This information demonstrates we can continue to treat orthopaedic trauma patients safely during the COVID-19 pandemic by utilizing strict safety protocols.
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Affiliation(s)
- Brian D. Batko
- Corresponding author. Rutgers New Jersey Medical School, 140 Bergen St., Suite D-1610, Newark, NJ, 07103, USA.
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Rates and risk factors associated with 90-day readmission following cervical spine fusion surgery: analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Spine J 2020; 20:708-716. [PMID: 31958576 DOI: 10.1016/j.spinee.2020.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Hospital readmission rates are an increasingly important focus. Identifying patients at risk for readmission can help decrease those rates and thus decrease the overall cost of care. PURPOSE We sought to report the rates and the risk factors associated with 90-day hospital readmission after degenerative cervical spine surgery via either an anterior or posterior approach. STUDY DESIGN Retrospective review of prospectively collected database PATIENT SAMPLE: Michigan Spine Surgery Improvement Collaborative (MSSIC) registry OUTCOME MEASURES: Hospital readmission at 90 days METHODS: The MSSIC registry prospectively enrolls patients undergoing surgery for degenerative cervical spine disease. The registry was queried over a 4-year period to determine patient characteristics and risk factors associated with unplanned readmission at 90 days following degenerative cervical spine fusion surgery through either an anterior or posterior approach. Univariate and multivariate regression modeling was used to compare patient characteristics and odds of readmission. RESULTS Of 3,762 patients who underwent an anterior approach, 202 (5.4%) were readmitted within 90 days. Of 693 patients who underwent a posterior approach, 85 (12.3%) were readmitted within 90 days. Risk factors associated with increased likelihood of readmission after the anterior approach were male sex (odds ratio [OR] 1.56, confidence interval [CI] 1.10-2.20), American Society of Anesthesiologists class >2 (OR 1.70, CI 1.26-2.30), and increased length of stay (OR 1.10, CI 1.03-1.19). Factors associated with decreased likelihood of readmission after the anterior approach were being independently ambulatory preoperatively (OR 0.59, CI 0.46-0.76) and holding private insurance (OR 0.67, CI 0.50-0.90). A history of previous spine surgery was associated with increased risk of readmission after the posterior approach (OR 1.76, CI 1.37-2.25). Pain was the most common single reason cited for readmission after either approach (9% anterior, 13% posterior). After an anterior approach, common surgical reasons for readmission include new radicular findings (8%), dysphagia (6%), and surgical site hematoma (5%), whereas common medical reasons include pneumonia (7%), infection outside the surgical site (6%), and an electrolyte issue. After a posterior approach, common surgical reasons for readmission after 90 days include surgical site infection (8%) and new radicular findings (6%), whereas common medical reasons include infection outside the surgical site (9%), urinary tract infection (8%), and an abdominal issue (8%). CONCLUSIONS Analysis of a large multicentered, spine-specific database for elective cervical spine fusion surgery demonstrated an unplanned 90-day readmission rate of 5.4% for the anterior approach and 12.3% for the posterior approach. Factors associated with readmission for the anterior approach include male sex, American Society of Anesthesiologists class >2, increased length of stay, holding private insurance, and being ambulatory preoperatively. A history of previous spine surgery was associated with increased odds of readmission after the posterior approach.
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Park P, Nerenz DR, Aleem IS, Schultz LR, Bazydlo M, Xiao S, Zakaria HM, Schwalb JM, Abdulhak MM, Oppenlander ME, Chang VW. Risk Factors Associated With 90-Day Readmissions After Degenerative Lumbar Fusion: An Examination of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Registry. Neurosurgery 2020; 85:402-408. [PMID: 30113686 DOI: 10.1093/neuros/nyy358] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most studies have evaluated 30-d readmissions after lumbar fusion surgery. Evaluation of the 90-d period, however, allows a more comprehensive assessment of factors associated with readmission. OBJECTIVE To assess the reasons and risk factors for 90-d readmissions after lumbar fusion surgery. METHODS The Michigan Spine Surgery Improvement Collaborative (MSSIC) registry is a prospective, multicenter, and spine-specific database of patients surgically treated for degenerative disease. MSSIC data were retrospectively analyzed for causes of readmission, and independent risk factors impacting readmission were found by multivariate logistic regression. RESULTS Of 10 204 patients who underwent lumbar fusion, 915 (9.0%) were readmitted within 90 d, most commonly for pain (17%), surgical site infection (16%), and radicular symptoms (10%). Risk factors associated with increased likelihood of readmission were other race (odds ratio [OR] 1.81, confidence interval [CI] 1.22-2.69), coronary artery disease (OR 1.57, CI 1.25-1.96), ≥4 fused levels (OR 1.41, CI 1.06-1.88), diabetes (OR 1.34, CI 1.10-1.63), and surgery length (OR 1.09, CI 1.03-1.16). Factors associated with decreased risk were discharge to home (OR 0.63, CI 0.51-0.78), private insurance (OR 0.79, CI 0.65-0.97), ambulation same day of surgery (OR 0.81, CI 0.67-0.97), and spondylolisthesis diagnosis (OR 0.82, CI 0.68-0.97). Of those readmitted, 385 (42.1%) patients underwent another surgery. CONCLUSION Ninety-day readmission occurred in 9.0% of patients, mainly for pain, wound infection, and radicular symptoms. Increased focus on postoperative pain may decrease readmissions. Among factors impacting the likelihood of 90-d readmission, early postoperative ambulation may be most easily modifiable. Optimization of preexisting medical conditions could also potentially decrease readmission risk.
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Affiliation(s)
- Paul Park
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - David R Nerenz
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Ilyas S Aleem
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Lonni R Schultz
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Michael Bazydlo
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Shujie Xiao
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Hesham M Zakaria
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
| | | | | | - Victor W Chang
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan
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Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE The objective of this study was to investigate the incidence of surgical site infection (SSI) in patients following spine surgery and the rate of microorganisms in these cases. SUMMARY OF BACKGROUND DATA Many studies have investigated the incidence and risk factors of SSI following spinal surgery, whereas no meta-analysis studies have been conducted regarding the comprehensive epidemiological incidence of SSI after spine surgery. METHODS We searched the PubMed, Embase, and Cochrane Library databases for relevant studies that reported the incidence of SSI after spine surgery, and manually screened reference lists for additional studies. Relevant incidence estimates were calculated. Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed. RESULTS Our meta-analysis included 27 studies, with 603 SSI cases in 22,475 patients. The pooled SSI incidence was 3.1%. Subgroup analysis revealed that the incidence of superficial SSI was 1.4% and the incidence of deep SSI was 1.7%. Highest incidence (13.0%) was found in patients with neuromuscular scoliosis among the different indications. The incidences of SSI in cervical, thoracic, and lumbar spine were 3.4%, 3.7%, and 2.7%, respectively. Compared with posterior approach surgery (5.0%), anterior approach showed a lower incidence (2.3%) of SSI. Instrumented surgery had a higher incidence of SSI than noninstrumented surgery (4.4% vs. 1.4%). Patients with minimally invasive surgery (1.5%) had a lower SSI incidence than open surgery (3.8%). Lower incidence of SSI was found when vancomycin powder was applied locally during the surgery (1.9%) compared with those not used (4.8%). In addition, the rates of Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococci in microbiological culture results were 37.9%, 22.7%, and 23.1%, respectively. CONCLUSION The pooled incidence of SSI following spine surgery was 3.1%. These figures may be useful in the estimation of the probability of SSI following spine surgery. LEVEL OF EVIDENCE 3.
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Madrid-García A, Font-Urgelles J, Vega-Barbas M, León-Mateos L, Freites DD, Lajas CJ, Pato E, Jover JA, Fernández-Gutiérrez B, Abásolo-Alcazar L, Rodríguez-Rodríguez L. Outpatient Readmission in Rheumatology: A Machine Learning Predictive Model of Patient's Return to the Clinic. J Clin Med 2019; 8:jcm8081156. [PMID: 31382409 PMCID: PMC6723392 DOI: 10.3390/jcm8081156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Our objective is to develop and validate a predictive model based on the random forest algorithm to estimate the readmission risk to an outpatient rheumatology clinic after discharge. We included patients from the Hospital Clínico San Carlos rheumatology outpatient clinic, from 1 April 2007 to 30 November 2016, and followed-up until 30 November 2017. Only readmissions between 2 and 12 months after the discharge were analyzed. Discharge episodes were chronologically split into training, validation, and test datasets. Clinical and demographic variables (diagnoses, treatments, quality of life (QoL), and comorbidities) were used as predictors. Models were developed in the training dataset, using a grid search approach, and performance was compared using the area under the receiver operating characteristic curve (AUC-ROC). A total of 18,662 discharge episodes were analyzed, out of which 2528 (13.5%) were followed by outpatient readmissions. Overall, 38,059 models were developed. AUC-ROC, sensitivity, and specificity of the reduced final model were 0.653, 0.385, and 0.794, respectively. The most important variables were related to follow-up duration, being prescribed with disease-modifying anti-rheumatic drugs and corticosteroids, being diagnosed with chronic polyarthritis, occupation, and QoL. We have developed a predictive model for outpatient readmission in a rheumatology setting. Identification of patients with higher risk can optimize the allocation of healthcare resources.
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Affiliation(s)
- Alfredo Madrid-García
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Judit Font-Urgelles
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Mario Vega-Barbas
- Dpto. Ingeniería Sistemas Telemáticos, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avda. Complutense 3, 28040 Madrid, Spain
| | - Leticia León-Mateos
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Dalifer Dayanira Freites
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Cristina Jesus Lajas
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Esperanza Pato
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Juan Angel Jover
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Benjamín Fernández-Gutiérrez
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Lydia Abásolo-Alcazar
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Luis Rodríguez-Rodríguez
- Rheumatology Department, and Health Research Institute (IdISSC), Hospital Clínico San Carlos, 28040 Madrid, Spain.
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11
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Management of Closed Incisions Using Negative-Pressure Wound Therapy in Orthopedic Surgery. Plast Reconstr Surg 2019; 143:21S-26S. [DOI: 10.1097/prs.0000000000005308] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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