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Smith TD, Wilson IR, Burnell C, Vernon J, Hedden DR, Turgeon TR. Multi-center experience with outpatient total hip arthroplasty via a standard posterolateral approach. PLoS One 2024; 19:e0292003. [PMID: 38483984 PMCID: PMC10939296 DOI: 10.1371/journal.pone.0292003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND This study sought to evaluate the safety, efficacy, and resource utilization of a pilot outpatient surgery program for total hip arthroplasty compared to traditional inpatient total hip arthroplasty performed via the posterolateral approach. METHODS A cohort of 68 patients from two sites were enrolled in a regional pilot project for outpatient total hip arthroplasty (THA) and matched 1:1 against a cohort of patients undergoing routine inpatient THA. Data was extracted retrospectively from patient and hospital charts including adverse events (AE), readmission within 90 days, emergency room (ER) visits, patient calls, patient-reported outcome measures, length of stay, and multiple surgical variables. RESULTS The outpatient group had a mean hospital stay of 13 hours, whereas the inpatient group had a mean of 58 hours (p<0.001). Three outpatients and four inpatients experienced post-op complications. Three inpatients and one outpatient visited the ER within 8 weeks of surgery. No difference in pre-operative hemoglobin (p = 0.210), or surgical blood loss (p = 0.550) was found between study groups. There was no difference found between groups regarding Oxford-12 Hip Score improvement, nor satisfaction at six months, one and two years (p>0.125). CONCLUSION This study demonstrates that outpatient THA using the posterolateral approach is as safe and effective as inpatient THA for overall healthy and carefully screened patients, based on the low rate of AEs observed and similar patient outcomes reported. Significantly reduced time in hospital demonstrates the reduced healthcare resources associated with outpatient THA.
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Affiliation(s)
- Thomas D. Smith
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian R. Wilson
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin Burnell
- Department of Surgery, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Vernon
- Fort Whyte Orthopedics, Winnipeg, Manitoba, Canada
| | - David R. Hedden
- Department of Surgery, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas R. Turgeon
- Department of Surgery, Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Zeng L, Cai H, Qiu A, Zhang D, Lin L, Lian X, Chen M. Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis. Medicine (Baltimore) 2023; 102:e35743. [PMID: 37960764 PMCID: PMC10637554 DOI: 10.1097/md.0000000000035743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue. METHODS Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class (OR, 1.502; 95%CI:1.405-1.605; P < .001), heart failure (OR,1.494; 95%CI: 1.235-1.754; P < .001), diabetes (OR, 1.246; 95%CI:1.128-1.377; P < .001), liver disease (OR, 1.339; 95%CI:1.237-1.450; P < .001), drinking (OR, 1.114; 95%CI:1.041-1.192; P = .002), depression (OR, 1.294; 95%CI:1.223-1.396; P < .001), urinary tract infection (OR, 5.879; 95%CI: 5.119-6.753; P < .001), and deep vein thrombosis (OR, 10.007; 95%CI: 8.787-11.396; P < .001) showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk. CONCLUSION The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.
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Affiliation(s)
- Liping Zeng
- Department of Orthopaedics, No. 910 Hospital of The Chinese People's Liberation Army Joint Logistic Support Force, Quanzhou, China
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Gardner RL, Baier RR, Cooper EL, Clements EE, Belanger E. Interventions to Reduce Hospital and Emergency Department Utilization Among People With Alcohol and Substance Use Disorders: A Scoping Review. Med Care 2022; 60:164-177. [PMID: 34908009 DOI: 10.1097/mlr.0000000000001676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Substance use disorders (SUDs), prevalent worldwide, are associated with significant morbidity and health care utilization. OBJECTIVES To identify interventions addressing hospital and emergency department utilization among people with substance use, to summarize findings for those seeking to implement such interventions, and to articulate gaps that can be addressed by future research. RESEARCH DESIGN A scoping review of the literature. We searched PubMed, PsycInfo, and Google Scholar for any articles published from January 2010 to June 2020. The main search terms included the target population of adults with substance use or SUDs, the outcomes of hospital and emergency department utilization, and interventions aimed at improving these outcomes in the target population. SUBJECTS Adults with substance use or SUDs, including alcohol use. MEASURES Hospital and emergency department utilization. RESULTS Our initial search identified 1807 titles, from which 44 articles were included in the review. Most interventions were implemented in the United States (n=35). Half focused on people using any substance (n=22) and a quarter on opioids (n=12). The tested approaches varied and included postdischarge services, medications, legislation, and counseling, among others. The majority of study designs were retrospective cohort studies (n=31). CONCLUSIONS Overall, we found few studies assessing interventions to reduce health care utilization among people with SUDs. The studies that we did identify differed across multiple domains and included few randomized trials. Study heterogeneity limits our ability to compare interventions or to recommend one specific approach to reducing health care utilization among this high-risk population.
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Affiliation(s)
- Rebekah L Gardner
- Department of Medicine, Alpert Medical School of Brown University
- Healthcentric Advisors
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
| | | | - Erin E Clements
- Public Health Program, Brown University School of Public Health
| | - Emmanuelle Belanger
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
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Kamau EB, Foronda C, Hernandez VH, Walters BA. Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project. J Dr Nurs Pract 2021; 15:JDNP-D-20-00060. [PMID: 34716277 DOI: 10.1891/jdnp-d-20-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions. OBJECTIVE The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions. METHODS This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts. RESULTS The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts. CONCLUSION This practice improvement project demonstrates successful translation of research into practice. IMPLICATIONS FOR NURSING The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.
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Affiliation(s)
- Emma Betty Kamau
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | - Cynthia Foronda
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
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Mehta SJ, Hume E, Troxel AB, Reitz C, Norton L, Lacko H, McDonald C, Freeman J, Marcus N, Volpp KG, Asch DA. Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2028328. [PMID: 33346847 PMCID: PMC7753899 DOI: 10.1001/jamanetworkopen.2020.28328] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/10/2020] [Indexed: 12/13/2022] Open
Abstract
Importance Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown. Objective To evaluate the effect of activity monitoring and bidirectional text messaging on the rate of discharge to home and clinical outcomes in patients receiving hip or knee arthroplasty. Design, Setting, and Participants Randomized clinical trial conducted between February 7, 2018, and April 15, 2019. The setting was 2 urban hospitals at an academic health system. Participants were patients aged 18 to 85 years scheduled to undergo hip or knee arthroplasty with a Risk Assessment and Prediction Tool score of 6 to 8. Interventions Eligible patients were randomized evenly to receive usual care (n = 153) or remote monitoring (n = 147). Those in the intervention arm who agreed received a wearable activity monitor to track step count, messaging about postoperative goals and milestones, pain score tracking, and connection to clinicians as needed. Patients assigned to receive monitoring were further randomized evenly to remote monitoring alone or remote monitoring with gamification and social support. Remote monitoring was offered before surgery, began at hospital discharge, and continued for 45 days postdischarge. Main Outcomes and Measures The primary outcome was discharge status (home vs skilled nursing facility or inpatient rehabilitation). Prespecified secondary outcomes included change in average daily step count and rehospitalizations. Results A total of 242 patients were analyzed (124 usual care, 118 intervention); median age was 66 years (interquartile range, 58-73 years); 78.1% were women, 45.5% were White, 43.4% were Black; and 81.4% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care arm (57.3%; 95% CI, 48.5%-65.9%) and the intervention arm (56.8%; 95% CI, 47.9%-65.7%) and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared with remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm (3.4%; 95% CI, 0.1%-6.7%) compared with the usual care arm (12.2%; 95% CI, 6.4%-18.0%) (P = .01). Conclusions and Relevance In this study, the remote monitoring program did not increase rate of discharge to home after hip or knee arthroplasty, and gamification and social support did not increase activity levels. There was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team. Trial Registration ClinicalTrials.gov Identifier: NCT03435549.
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Affiliation(s)
- Shivan J. Mehta
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Eric Hume
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Andrea B. Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Catherine Reitz
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Laurie Norton
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Hannah Lacko
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia
| | - Caitlin McDonald
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
| | - Jason Freeman
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Noora Marcus
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
| | - Kevin G. Volpp
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - David A. Asch
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
- Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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Mahajan SM, Nguyen C, Bui J, Kunde E, Abbott BT, Mahajan AS. Risk Factors for Readmission After Knee Arthroplasty Based on Predictive Models: A Systematic Review. Arthroplast Today 2020; 6:390-404. [PMID: 32577484 PMCID: PMC7303919 DOI: 10.1016/j.artd.2020.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/29/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND An increase in the aging yet active US population will continue to make total knee arthroplasty (TKA) procedures routine in the coming decades. For such joint procedures, the Centers for Medicare and Medicaid Services introduced programs such as the Comprehensive Care for Joint Replacement to emphasize accountable and efficient transitions of care. Accordingly, many studies have proposed models using risk factors for predicting readmissions after the procedure. We performed a systematic review of TKA literature to identify such models and risk factors therein using a reliable appraisal tool for their quality assessment. METHODS Five databases were searched to identify studies that examined correlations between post-TKA readmission and risk factors using multivariate models. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and Transparent Reporting of a multivariate prediction model for Individual Prognosis Or Diagnosis criteria established for quality assessment of prognostic studies. RESULTS Of 29 models in the final selection, 6 models reported performance using a C-statistic, ranging from 0.51 to 0.76, and 2 studies used a validation cohort for assessment. The average 30-day and 90-day readmission rates across the studies were 5.33% and 7.12%, respectively. Three new significant risk factors were discovered. CONCLUSIONS Current models for TKA readmissions lack in performance measurement and reporting when assessed with established criteria. In addition to using new techniques for better performance, work is needed to build models that follow the systematic process of calibration, external validation, and reporting for pursuing their deployment in clinical settings.
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Affiliation(s)
- Satish M. Mahajan
- Research & Innovation, Patient Care Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Chantal Nguyen
- Research & Innovation, Patient Care Services, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Justin Bui
- Research & Innovation, Patient Care Services, Lake Erie College of Osteopathic Medicine at Bradenton, Bradenton, FL, USA
| | - Enomwoyi Kunde
- Research & Innovation, Patient Care Services, Adult Clinic, Roots Community Health Center, Oakland, CA, USA
| | - Bruce T. Abbott
- Research & Innovation, Patient Care Services, Blaisdell Medical Library, University of California, Sacramento, CA, USA
| | - Amey S. Mahajan
- Research & Innovation, Patient Care Services, C2OPS Inc., Cupertino, CA, USA
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Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder. J Addict Med 2020; 13:306-313. [PMID: 30633044 DOI: 10.1097/adm.0000000000000499] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD). METHODS This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P < 0.10) on univariate analysis. RESULTS Among the 470 adults (mean age 43.1 ± 12.8 years, past heroin use 77.9%; admission opioid agonist therapy use [buprenorphine 22.6%; methadone 27.0%]; medical [vs surgical] admission 75.3%, floor [vs ICU] admission 93.0%, in-hospital mortality 0.9%), 85 (18.2%) and 151 (32.1%) were readmitted within 30 and 90 days, respectively. Among the 90-day readmitted patients, median time to first readmission was 26 days. Buprenorphine use (vs no use) at index hospital admission was independently associated with reduced 30-day (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.24-0.93) and 90-day (OR 0.57, 95% CI 0.34-0.96) readmission; prior heroin (vs prescription opioid) use was associated with reduced 90-day readmission (OR 0.59, 95% CI 0.37-0.94) and length of hospital stay was associated with both greater 30-day (OR 1.02, 95% CI 1.01-1.05) and 90-day (OR 1.04, 95% CI 1.01-1.06) readmission rates. CONCLUSIONS Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.
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Gould D, Dowsey M, Spelman T, Jo I, Kabir W, Trieu J, Choong P. Patient-related risk factors for unplanned 30-day readmission following total knee arthroplasty: a protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:215. [PMID: 31439039 PMCID: PMC6706890 DOI: 10.1186/s13643-019-1140-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/13/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Osteoarthritis is a debilitating condition as well as a growing global health problem, and total knee arthroplasty is an effective treatment for advanced stages of disease. Unplanned 30-day hospital readmission is an indicator of complications, which is a significant financial burden on healthcare systems. The objective is to perform a systematic review of patient-related factors associated with unplanned 30-day readmission following total knee arthroplasty. This information will inform future strategies to improve health outcomes after knee arthroplasty surgery. METHODS MEDLINE and EMBASE will be systematically searched using a comprehensive search strategy. Studies of higher quality than case series will be included, in order to optimise the quality of the findings of this review. We will include studies reporting on patient-related risk factors for unplanned 30-day readmission following primary or revision total knee arthroplasty for any indication. Case series will be excluded, as will studies reporting exclusively on intraoperative, clinician, hospital, and health system risk factors. The reference lists of selected papers will then be screened for any additional literature. Two reviewers will independently apply stringent eligibility criteria to titles, abstracts, and full texts of studies identified in the literature search. They will then extract data from the final list of selected papers according to an agreed-upon taxonomy and vocabulary of the data to be extracted. Assessment of risk of bias and quality of evidence will then take place. Finally, the effect size of each identified risk factor will be determined; meta-analysis will be performed where adequate data is available. DISCUSSION The findings of this review and subsequent meta-analysis will aid clinicians as they seek to understand the risk factors for 30-day readmission following total knee arthroplasty. Clinicians and patients will be able to use this information to align expectations of the postoperative course, which will enhance the recovery process, and aid in the development of strategies to mitigate identified risks. Another purpose of this review is to assist policy-makers in developing quality indicators for care and provide insights into the drivers of health costs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019118154.
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Affiliation(s)
- Daniel Gould
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
| | - Michelle Dowsey
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
- Department of Othopaedics at St. Vincent’s Hospital Melbourne, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, 3065 Australia
| | - Tim Spelman
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
| | - Imkyeong Jo
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
| | - Wassif Kabir
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
| | - Jason Trieu
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
| | - Peter Choong
- University of Melbourne Department of Surgery at St. Vincent’s Hospital Melbourne, Level 2 Clinical Sciences Building, 29 Regent Street, Fitzroy, 3065 Australia
- Department of Othopaedics at St. Vincent’s Hospital Melbourne, Level 3 Daly Wing, 35 Victoria Parade, Fitzroy, 3065 Australia
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The Validity of All-Cause 30-Day Readmission Rate as a Hospital Performance Metric After Primary Total Hip and Knee Arthroplasty: A Systematic Review. J Arthroplasty 2019; 34:1831-1836. [PMID: 31072744 DOI: 10.1016/j.arth.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Risk-adjusted all-cause 30-day readmission rate (ACRR) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is currently used as a metric of hospital performance as part of the Hospital Readmissions Reduction Program. However, the extent to which it is determined by hospital-related factors and is therefore a fair method of determining reimbursement remains unclear. METHODS Our aim was to systematically review the available literature pertaining to whether ACRR is a valid metric of hospital performance after elective primary THA or TKA as determined by (1) its association with other performance metrics, (2) the extent to which variation in ACRR can be explained by between-hospital variation, and (3) the relative importance of hospital-related versus surgeon- or patient-related factors in determining ACRR. The MEDLINE, EMBASE, and Health Management Information Consortium databases were searched from inception to November 2018 and reference lists of selected articles scanned. The final list of articles was determined by consensus. RESULTS Eight articles were included. Correlation of ACRR with established composite metrics of both outcome and process measures was poor. There was a weak positive correlation between ACRR and mortality. Only 1.5% of the variation in readmission rates for THA and TKA was found to be attributable to hospital-level factors, with patient-related factors such as age and comorbidities having much greater influence. Use of composite outcome metrics, for example, combining readmission and mortality, or considering the "surgical" readmission rate, improved the sensitivity to detect important between-hospital variation. CONCLUSION There is insufficient evidence in the current literature to justify the use of ACRR following elective THA and TKA for financially penalizing hospitals. Further work is needed to define what is acceptable variation. The use of a composite metric or surgical readmission rate may improve the ability to detect between-hospital variation.
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Kim KY, Feng JE, Anoushiravani AA, Dranoff E, Davidovitch RI, Schwarzkopf R. Rapid Discharge in Total Hip Arthroplasty: Utility of the Outpatient Arthroplasty Risk Assessment Tool in Predicting Same-Day and Next-Day Discharge. J Arthroplasty 2018; 33:2412-2416. [PMID: 29656963 DOI: 10.1016/j.arth.2018.03.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA) episode of care, and as a result, significant efforts are being made to minimize it. This study aims to assess the utility of the Outpatient Arthroplasty Risk Assessment (OARA) screening tool in accurately identifying patients for safe and early discharge after THA. METHODS A retrospective review was conducted on 332 consecutive patients who underwent primary THA at a single tertiary academic center. Patients were evaluated using the OARA score, a tool that has been proposed to identify patients who can safely undergo early discharge after THA. The validity of these claims was assessed by analyzing the OARA score's positive and negative predictive values for high vs low OARA scores between patients enrolled in our (1) same-day discharge (SDD) and 2) next-day discharge (NDD) pathways. RESULTS When comparing the utility of the OARA score in accurately predicting length of stay, the OARA score demonstrated a (1) higher, but constant, positive predictive value for discharge on postoperative day (POD) 0 for SDD (86.1%) than POD1 for NDD (35.5%) and (2) lower negative predictive value for discharge on POD0 (23.1%) for SDD than POD1 for NDD (86.1%). CONCLUSION The OARA score was developed to risk-stratify patients who can safely undergo SDD or NDD after THA. In this study, the OARA score was a highly predictive tool in identifying NDD patients at risk for failure of discharge by POD1.
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Affiliation(s)
- Kelvin Y Kim
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | - James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | - Edward Dranoff
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | - Roy I Davidovitch
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, New York
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11
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Bagante F, Beal EW, Merath K, Paredes A, Chakedis J, Olsen G, Akgül O, Idrees J, Chen Q, Pawlik TM. The impact of a malignant diagnosis on the pattern and outcome of readmission after liver and pancreatic surgery: An analysis of the nationwide readmissions database. J Surg Oncol 2018; 117:1624-1637. [PMID: 29957864 DOI: 10.1002/jso.25065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/18/2018] [Indexed: 12/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Reducing readmissions is an important quality improvement metric. We sought to investigate patterns of 90-day readmission after hepato-pancreatic (HP) procedures. METHODS The Nationwide Readmissions Database (NRD) was used to identify patients undergoing HP procedures between 2010 and 2014. Patients were stratified according to benign versus malignant HP diagnoses and as index (same hospital as operation) versus non-index (different hospital) readmissions. RESULTS Among the 41 059 patients who underwent HP procedures, 26 563 (65%) underwent a liver resection while 14 496 (35%) pancreatic resection. Among all patients, 11 902 (29%) had a benign diagnosis versus 29 157 (71%) who had a cancer diagnosis. Overall 90-day readmission was 22% (n = 8 998) with a slight increase in readmissions among patients with a malignant (n = 6 655;23%) versus benign (n = 2 343;20%) diagnosis (P < 0.001). Readmission to an index hospital was more common (n = 7 316 81%) versus a non-index hospital (n = 1 682 19%). Non-index hospital readmissions were more frequent among patients with malignant HP diagnoses (OR, 1.41;P = 0.001). CONCLUSIONS Up to one in four patients were readmitted after HP surgery. Late readmission was more common among patients with a cancer-diagnosis. While most readmissions occurred at the index hospital, 19% of all readmissions occurred at a non-index hospital and were more frequent among patients with malignant diagnoses.
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Affiliation(s)
- Fabio Bagante
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
- General and Hepatobiliary Surgery, Department of Surgery, University of Verona, School of Medicine, Verona, Italy
| | - Eliza W Beal
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Katiuscha Merath
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Anghela Paredes
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffery Chakedis
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Griffin Olsen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ozgür Akgül
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jay Idrees
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Quinu Chen
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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