Westermann Robert W, Pugely Andrew J, Ries Zachary, Amendola Annunziato, Martin Christopher T, Gao Yubo, Wolf Brian R
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A..
Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.
Arthroscopy. 2015 Jun;31(6):1035-1040.e1. doi: 10.1016/j.arthro.2015.03.029.
To evaluate the incidence, causes, and risk factors for unplanned 30-day readmission after shoulder and knee arthroscopy.
A multicenter, prospective clinic registry, the American College of Surgeons National Surgical Quality Improvement Program, was queried for Current Procedural Terminology codes representing the most common shoulder and knee arthroscopic procedures. Unplanned readmissions within 30 days were evaluated dichotomously, and causes of readmission were identified. Univariate and multivariate logistic regression analyses were used to identify variables predictive of readmission.
In total, we identified 15,167 patients who underwent shoulder and knee arthroscopic procedures in 2012. Overall, 136 (0.90%) were readmitted within 30 days, and the rates were similar after shoulder (0.86%) and knee (0.92%) procedures. Readmissions were most common after arthroscopic debridement of the knee (1.56%) and lowest after rotator cuff and labral repairs (0.68%) and cruciate reconstructions (0.78%). The most common causes of readmission were surgical-site infections (37.1%), deep venous thrombosis and pulmonary embolism (17.1%), and postoperative pain (7.1%). Multivariate analysis identified age older than 80 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.5 to 8.1), chronic steroid use (OR, 3.3; 95% CI, 1.5 to 7.2), and elevated American Society of Anesthesiologists class (OR, 4.2; 95% CI, 1.4 to 12.0) as independent risk factors for readmission.
The rate of unplanned readmissions within 30 days of shoulder and knee arthroscopic procedures is low, at 0.92%, with wound-related complications being the most common cause. In patients with advanced age, with chronic steroid use, and with chronic systemic disease, the risk of readmission may be higher. These findings may aid in the informed-consent process, patient optimization, and the quality-reporting risk-adjustment process.
Level III, prognostic study.
评估肩、膝关节镜检查后30天内非计划再入院的发生率、原因及危险因素。
通过多中心前瞻性临床登记系统，即美国外科医师学会国家外科质量改进计划，查询代表最常见肩、膝关节镜手术的当前操作术语代码。对30天内的非计划再入院情况进行二分法评估，并确定再入院原因。采用单因素和多因素逻辑回归分析来确定预测再入院的变量。
2012年，我们共确定了15167例接受肩、膝关节镜手术的患者。总体而言，136例（0.90%）在30天内再次入院，肩关节手术（0.86%）和膝关节手术（0.92%）后的再入院率相似。膝关节镜下清创术后再入院最为常见（1.56%），肩袖和盂唇修复术后（0.68%）及交叉韧带重建术后（0.78%）最低。再入院的最常见原因是手术部位感染（37.1%）、深静脉血栓形成和肺栓塞（17.1%）以及术后疼痛（7.1%）。多因素分析确定年龄大于80岁（比值比[OR]，3.5；95%置信区间[CI]，1.5至8.1）、长期使用类固醇（OR，3.3；95%CI，1.5至7.2）以及美国麻醉医师协会分级升高（OR，4.2；95%CI，1.4至12.0）为再入院的独立危险因素。
肩、膝关节镜手术后30天内非计划再入院率较低，为0.92%，伤口相关并发症是最常见原因。对于高龄、长期使用类固醇以及患有慢性全身性疾病的患者，再入院风险可能更高。这些发现可能有助于知情同意过程、患者优化以及质量报告风险调整过程。
III级，预后研究。
