Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street, Box 124, New York, NY, 10065, USA.
Department of Anesthesiology, Weill Cornell Medicine Center for Perioperative Outcomes, 428 East 72nd Street, Ste 800A, New York, NY, 10021, USA.
J Racial Ethn Health Disparities. 2018 Dec;5(6):1202-1214. doi: 10.1007/s40615-018-0467-0. Epub 2018 Feb 12.
Total hip replacements (THRs) are the sixth most common surgical procedure performed in the USA. Readmission rates are estimated at between 4.0 and 10.9%, and mean costs are between $10,000 and $19,000. Readmissions are influenced by the quality of care received. We sought to examine differences in readmissions by insurance payer, race and ethnicity, and income status.
We analyzed all THRs from 2007 to 2011 in California, Florida, and New York from the State Inpatient Databases, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Primary outcomes were readmission at 30 and 90 days after THR. Descriptive statistics were calculated, and multivariate logistic regression analysis was used to estimate adjusted odds ratio (OR) for readmissions. Statistical significance was evaluated at the < 0.05 alpha level.
A total of 274,851 patients were included in the analyses. At 30 days (90 days), 5.6% (10.2%) patients had been readmitted. Multivariate logistic regression analysis showed that patients insured by Medicaid (OR 1.23, 95%CI 1.17-1.29) and Medicare (OR 1.58, 95%CI 1.44-1.73) had increased odds of 30-day readmission, as did patients living in areas with lower incomes, Black patients, and patients treated at lower volume hospitals. Ninety-day readmissions showed similar significant results.
The present study has shown that patients on public insurance, Black patients, and patients who live in areas with lower median incomes have higher odds of readmission. Future research should focus on further identifying racial and socioeconomic disparities in readmission after THR with an eye towards implementing strategies to ameliorate these differences.
全髋关节置换术（THR）是美国第六大常见的手术。再入院率估计在 4.0%至 10.9%之间，平均费用在 10000 美元至 19000 美元之间。再入院率受所接受的护理质量的影响。我们试图检查保险支付人、种族和民族以及收入状况对再入院率的差异。
我们分析了来自加利福尼亚州、佛罗里达州和纽约州的 2007 年至 2011 年期间的所有 THR，这些数据来自州住院患者数据库、医疗保健成本和利用项目、医疗保健研究和质量局。主要结果是 THR 后 30 天和 90 天的再入院率。计算了描述性统计数据，并使用多变量逻辑回归分析来估计再入院率的调整比值比（OR）。评估统计显著性的 alpha 水平为<0.05。
共纳入 274851 例患者进行分析。在 30 天（90 天）时，5.6%（10.2%）的患者被再入院。多变量逻辑回归分析显示，由医疗补助（OR 1.23，95%CI 1.17-1.29）和医疗保险（OR 1.58，95%CI 1.44-1.73）承保的患者以及收入较低地区的患者、黑人患者和在低容量医院接受治疗的患者，30 天再入院的可能性更高。90 天的再入院也显示出类似的显著结果。
本研究表明，公共保险患者、黑人患者和收入较低地区的患者再入院的可能性更高。未来的研究应重点进一步确定 THR 后再入院的种族和社会经济差异，并着眼于实施改善这些差异的策略。
