Ricciardi Benjamin F, Oi Kathryn K, Daines Steven B, Lee Yuo-Yu, Joseph Amethia D, Westrich Geoffrey H
Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
J Arthroplasty. 2017 Apr;32(4):1074-1079. doi: 10.1016/j.arth.2016.10.019. Epub 2016 Oct 21.
Changes in reimbursement for total hip and knee arthroplasties (THA and TKA) have placed increased financial burden of early readmission on hospitals and surgeons. Our purpose was to characterize factors of 30-day readmission for surgical complications after THA and TKA at a single, high-volume orthopedic specialty hospital.
Patients with a diagnosis of osteoarthritis and who were readmitted within 30 days of their unilateral primary THA or TKA procedure between 2010 and 2014. Readmitted patients were matched to nonreadmitted patients 1:2. Patient and perioperative variables were collected for both cohorts. A conditional logistic regression was performed to assess both the patient and perioperative factors and their predictive value toward 30-day readmission.
Twenty-one thousand eight hundred sixty-four arthroplasties (THA = 11,105; TKA = 10,759) were performed between 2010 and 2014 at our institution, in which 60 patients (THA = 37, TKA = 23) were readmitted during this 5-year period. The most common reasons for readmission were fracture (N = 14), infection (N = 14), and dislocation (N = 9). Thirty-day readmission for THA was associated with increased procedure time (P = .05), length of stay (LOS) shorter than 2 days (P = .04), discharge to a skilled nursing facility (P = .05), and anticoagulation use other than aspirin (P = .02). Thirty-day readmission for TKA was associated with increased tourniquet time (P = .02), LOS <3 days (P < .01), and preoperative depression (P = .02). In the combined THA/TKA model, a diagnosis of depression increased 30-day readmission (odds ratio 3.5 [1.4-8.5]; P < .01).
Risk factors for 30-day readmission for surgical complications included short LOS, discharge destination, increased procedure/tourniquet time, potent anticoagulation use, and preoperative diagnosis of depression. A focus on risk factor modification and improved risk stratification models are necessary to optimize patient care using readmission rates as a quality benchmark.
全髋关节置换术（THA）和全膝关节置换术（TKA）报销政策的变化给医院和外科医生带来了更高的早期再入院经济负担。我们的目的是确定一家大型骨科专科医院中THA和TKA术后30天因手术并发症再入院的相关因素。
纳入2010年至2014年间诊断为骨关节炎且在单侧初次THA或TKA手术后30天内再次入院的患者。将再次入院患者与未再次入院患者按1:2进行匹配。收集两组患者的患者及围手术期变量。进行条件逻辑回归分析，以评估患者及围手术期因素及其对30天再入院的预测价值。
2010年至2014年间，我院共进行了21864例关节置换术（THA = 11105例；TKA = 10759例），其中60例患者（THA = 37例，TKA = 23例）在这5年期间再次入院。最常见的再入院原因是骨折（n = 14）、感染（n = 14）和脱位（n = 9）。THA术后30天再入院与手术时间延长（P = 0.05）、住院时间（LOS）短于2天（P = 0.04）、出院至专业护理机构（P = 0.05）以及使用除阿司匹林以外的抗凝药物（P = 0.02）有关。TKA术后30天再入院与止血带使用时间延长（P = 0.02）、LOS <3天（P < 0.01）和术前抑郁（P = 0.02）有关。在THA/TKA联合模型中，抑郁诊断增加了30天再入院率（比值比3.5 [1.4 - 8.5]；P < 0.01）。
手术并发症30天再入院的危险因素包括住院时间短、出院目的地、手术/止血带时间延长、强效抗凝药物使用以及术前抑郁诊断。以再入院率作为质量基准，关注危险因素的调整和改进风险分层模型对于优化患者护理是必要的。
