Cantrell Colin K, DeBell Henry A, Lehtonen Eva J, Patel Harshadkumar A, McKissack Haley M, McGwin Gerald, Shah Ashish, Naranje Sameer
Department of Orthopaedic Surgery, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, USA.
Department of Public Health, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, USA.
J Clin Orthop Trauma. 2020 Jan-Feb;11(1):38-42. doi: 10.1016/j.jcot.2018.10.017. Epub 2018 Oct 25.
The number of total hip arthroplasties (THA) being performed has been steadily increasing for decades. With increased primary THA surgical volume, revision THA numbers are also increasing at a steady pace. With the aging, increasingly comorbid patient populations and newly imposed financial penalties for hospitals with high readmission rates, refining understanding of factors influencing readmission following THA is a research priority. We hypothesize that numerous preoperative medical comorbidities and postoperative medical complications will emerge as significant positive risk factors for 30-day readmission.
ACS-NSQIP database identified patients who underwent revision THA from 2005 to 2015. The primary outcome assessed was hospital readmission within 30 days. Patient demographics, preoperative comorbidities, laboratory studies, operative characteristics, and postsurgical complications were compared between readmitted and non-readmitted patients. Logistic regression identified significant independent risk factors for 30-day readmission among these variables.
10,032 patients underwent revision THA in the ACS-NSQIP from 2005 to 2015; 855 (8.5%) were readmitted within 30-days. Increasing age, the presence of preoperative comorbidities, high ASA class, and increased operative time were significant positively associated independent risk factors for 30-day readmission. Several postoperative medical and surgical complications such as myocardial infarction, stroke, pneumonia, and sepsis demonstrated significant positive associations with readmission.
Identifying and understanding risk factors associated with readmission allows for the implementation of evidence-based interventions aimed at minimizing risk and reducing 30-day readmission rates following revision THA.
几十年来，全髋关节置换术（THA）的实施数量一直在稳步增加。随着初次THA手术量的增加，翻修THA的数量也在稳步上升。鉴于患者群体老龄化、合并症日益增多，以及医院因高再入院率而面临新的经济处罚，深入了解影响THA术后再入院的因素成为一项研究重点。我们假设，众多术前内科合并症和术后内科并发症将成为30天再入院的显著正性危险因素。
ACS-NSQIP数据库确定了2005年至2015年接受翻修THA的患者。评估的主要结局是30天内再次入院情况。对再入院患者和未再入院患者的人口统计学特征、术前合并症、实验室检查、手术特征及术后并发症进行了比较。逻辑回归分析确定了这些变量中30天再入院的显著独立危险因素。
2005年至2015年，ACS-NSQIP中有10,032例患者接受了翻修THA；855例（8.5%）在30天内再次入院。年龄增加、术前存在合并症、ASA分级高以及手术时间延长是30天再入院的显著正性相关独立危险因素。几种术后内科和外科并发症，如心肌梗死、中风、肺炎和败血症，与再入院呈显著正相关。
识别和了解与再入院相关的危险因素有助于实施基于证据的干预措施，以降低翻修THA后的风险并减少30天再入院率。
