Avinash Mahender, Rajasekaran S, Aiyer Siddharth N
Department of Orthopaedic Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
J Orthop. 2017 Mar 12;14(2):236-240. doi: 10.1016/j.jor.2017.03.001. eCollection 2017 Jun.
Unplanned readmissions are an undesirable and expensive outcome of clinical practice. Previous reported literature is limited by retrospective study designs and 30 day study intervals. We analyzed causes for 90-day unplanned readmission, temporal occurrence of major causes, possible predisposing factors, bed days lost and economic impact.
MATERIALS & METHODS: A prospective analysis of 12729 admissions was performed over 1 year in an Orthopaedic unit. Consecutive readmissions for unplanned circumstances within 90-days of discharge following the index procedure were included. Open injuries, polytrauma, primary osseous infections and planned readmissions were excluded.
We noted an overall readmission rate of 2.07% and subspecialty rate of 1.43%, 3.32%, 2.9% in trauma, spine and total joint arthroplasty (TJA) respectively. The leading cause was wound complications accounting for 49.62%, followed by medical causes (trauma -18.37%; TJA -27.5%) and aseptic pain (spine-31.6%). Though 87.1% of superficial surgical site infections (SSIs) occurred within 30 days, 21.1%, 41.2% and 60% of the deep SSIs in spine, trauma and TJA respectively occurred beyond 30 days. The financial burden amounted to INR 1,01,55,770 and mean bed days lost was 7.6 per readmission. Age ≥70 years, indoor-stay ≥10 days, health insurance and co-morbid illnesses were associated with readmissions (p < 0.05).
Our study showed that limiting analysis to 30 day unplanned readmissions would lead to failure in identification of 34.85% of readmissions especially deep surgical site infections in TJA and trauma.
非计划再入院是临床实践中不良且昂贵的结果。先前报道的文献受回顾性研究设计和30天研究间隔的限制。我们分析了90天非计划再入院的原因、主要原因的时间发生情况、可能的诱发因素、住院天数损失及经济影响。
在一个骨科单元对12729例入院病例进行了为期1年的前瞻性分析。纳入了在初次手术后90天内因非计划情况连续再入院的病例。开放性损伤、多发伤、原发性骨感染和计划性再入院被排除。
我们注意到总体再入院率为2.07%，创伤、脊柱和全关节置换术（TJA）的亚专业再入院率分别为1.43%、3.32%、2.9%。主要原因是伤口并发症，占49.62%，其次是医疗原因（创伤-18.37%；TJA-27.5%）和无菌性疼痛（脊柱-31.6%）。虽然87.1%的表浅手术部位感染（SSIs）发生在30天内，但脊柱、创伤和TJA中分别有21.1%、41.2%和60%的深部SSIs发生在30天之后。经济负担达10155770印度卢比，每次再入院平均住院天数损失为7.6天。年龄≥70岁、住院时间≥10天、医疗保险和合并疾病与再入院相关（p<0.05）。
我们的研究表明，将分析局限于30天非计划再入院会导致无法识别34.85%的再入院病例，尤其是TJA和创伤中的深部手术部位感染。
