Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY.
J Arthroplasty. 2019 Jan;34(1):20-26. doi: 10.1016/j.arth.2018.08.032. Epub 2018 Aug 31.
Thirty-day hospital readmissions following total hip arthroplasty (THA) have received increasing scrutiny by policy makers and hospitals. Emergency department (ED) visits may not necessarily result in an inpatient readmission but can be a measure of performance and can incur costs to the health system. The purpose of this study is to describe the following: (1) the frequency and subsequent disposition; (2) patient characteristics; (3) reasons; and (4) potential risk factors for ED visits that did not result in a readmission within 30 days of discharge after THA.
All primary THAs performed at a large healthcare system between 2013 and 2015 were identified. Patients who received unplanned hospital services for complications within 30 days following surgery were identified and analyzed. A multiple regression analysis was utilized to identify risk factors predisposing for returning to the ED without readmission.
From a total of 6270 primary THAs, 440 patients (7%) had an unplanned return to the hospital within 30 days. Of those, 227 (3.6%) patients presented to the ED and were not readmitted. Higher percentage of African Americans was noted among patients who returned to the ED versus those who did not (20.2% vs 9.8%, P < .01). The most common medical diagnoses were nonspecific medical symptoms (24.8%) followed by minor gastrointestinal problems (10.5%). The most common surgery-related diagnoses were pain and swelling (35%), followed by wound complications (12%) and hip dislocations (7.3%). Nearly 50% of wound complications and 40% of hip dislocations were managed and discharged from the ED without a readmission. Both African Americans (odds ratio 2.28, 95% confidence interval 1.55-3.36) and home discharge (odds ratio 1.90, 95% confidence interval 1.28-2.82) were independent risk factors for return to the ED without readmission.
ED visits that do not result in hospital readmissions, many of which may be due to serious complications, are more frequent than inpatient readmission. This is extremely relevant to policy makers and quality metrics, especially as comprehensive and bundled payment initiatives become more prevalent.
全髋关节置换术（THA）后 30 天内的医院再入院率受到政策制定者和医院越来越多的关注。急诊科（ED）就诊不一定导致住院再入院，但可以作为绩效衡量标准，并给医疗系统带来成本。本研究的目的是描述以下内容：（1）就诊频率及后续处理；（2）患者特征；（3）原因；以及（4）THA 出院后 30 天内无再入院的 ED 就诊的潜在危险因素。
确定了一家大型医疗保健系统在 2013 年至 2015 年期间进行的所有初次 THA。确定了术后 30 天内因并发症接受非计划住院服务的患者，并进行了分析。采用多元回归分析确定导致无再入院而返回 ED 的危险因素。
在总共 6270 例初次 THA 中，有 440 例（7%）患者在 30 天内计划外返回医院。其中，227 例（3.6%）患者前往 ED 就诊但未再入院。返回 ED 的患者中，非裔美国人的比例高于未返回的患者（20.2%比 9.8%，P <.01）。最常见的医疗诊断是非特异性的医疗症状（24.8%），其次是轻微的胃肠道问题（10.5%）。最常见的手术相关诊断是疼痛和肿胀（35%），其次是伤口并发症（12%）和髋关节脱位（7.3%）。近 50%的伤口并发症和 40%的髋关节脱位在 ED 得到治疗并出院，无需再入院。非裔美国人（优势比 2.28，95%置信区间 1.55-3.36）和家庭出院（优势比 1.90，95%置信区间 1.28-2.82）是无再入院返回 ED 的独立危险因素。
不会导致住院再入院的 ED 就诊比住院再入院更为常见，其中许多就诊可能是由于严重并发症所致。这对政策制定者和质量指标极为重要，尤其是随着全面和捆绑支付计划的日益普及。
