Zawadzki Nadine, Wang Yao, Shao Hui, Liu Emelline, Song Chao, Schoonmaker Michele, Shi Lizheng
Global Health Management and Policy, Tulane University, New Orleans, LA Healthcare Economics and Outcomes Research, Intuitive Surgical, CA CEPHEID, Sunnyvale.
Medicine (Baltimore). 2017 Sep;96(38):e7961. doi: 10.1097/MD.0000000000007961.
Policymakers have expanded readmissions penalty programs to include elective arthroplasties, but little is known about the risk factors for readmissions following these procedures. We hypothesized that infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) lead to excess readmissions and increased costs. This study aims to evaluate the proportion of readmissions due to infections following THA and TKA.Healthcare Cost and Utilization Project-State Inpatient Databases were used for the study. Procedure codes "8151" and "8154" were used to identify inpatient discharges with THA and TKA in Florida (FL) 2009 to 2013, Massachusetts (MA) 2010 to 2012, and California (CA) 2009 to 2011. Readmission was measured by a Centers for Medicare and Medicaid Services (CMS) validated algorithm. Infections were identified by ICD-9-CM codes: 99859, 99666, 6826, 0389, 486, 4821, 00845, 5990, 48242, 04111, 04112, 04119, 0417, 99591, and 99592. Descriptive analysis was performed.In CA, 4.29% of patients were readmitted with 33.02% of the total readmissions for infection. In FL, 4.7% of patients were readmitted with 33.39% of the readmissions for infection. In MA, 3.92% of patients were readmitted with 35.2% of readmissions for infection. Of the total number of readmissions due to infection, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) together accounted for 14.88% in CA, 13.38% in FL, and 13.11% in MA.The rate of infection is similar across all 3 states and is a leading cause for readmission following THA and TKA. Programs to reduce the likelihood of MRSA or MSSA infection would reduce readmissions due to infection.
政策制定者已扩大再入院惩罚计划，将择期关节置换术纳入其中，但对于这些手术后再入院的风险因素却知之甚少。我们假设全髋关节置换术（THA）和全膝关节置换术（TKA）后的感染会导致过多的再入院情况及成本增加。本研究旨在评估THA和TKA后因感染导致的再入院比例。
研究使用了医疗成本和利用项目-州住院数据库。程序代码“8151”和“8154”用于识别2009年至2013年佛罗里达州（FL）、2010年至2012年马萨诸塞州（MA）以及2009年至2011年加利福尼亚州（CA）接受THA和TKA的住院患者出院情况。再入院情况通过医疗保险和医疗补助服务中心（CMS）验证的算法进行衡量。感染通过ICD-9-CM代码识别：99859、99666、6826、0389、486、4821、00845、5990、48242、04111、04112、04119、0417、99591和99592。进行了描述性分析。
在加利福尼亚州，4.29%的患者再次入院，因感染导致的再入院占总再入院人数的33.02%。在佛罗里达州，4.7%的患者再次入院，因感染导致的再入院占33.39%。在马萨诸塞州，3.92%的患者再次入院，因感染导致的再入院占35.2%。在因感染导致的再入院总数中，耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA）在加利福尼亚州共占14.88%，在佛罗里达州占13.38%，在马萨诸塞州占13.11%。
所有三个州的感染率相似，且是THA和TKA后再入院的主要原因。降低MRSA或MSSA感染可能性的项目将减少因感染导致的再入院情况。
