Department of Orthopaedics, 37680Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Department of Orthopaedic Surgery and Rehabilitation, 21782University of Iowa Hospital and Clinics, Iowa City, IA, USA.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020959160. doi: 10.1177/2309499020959160.
Readmission following total joint arthroplasty has become a closely watched metric for many hospitals in the United States due to financial penalties imposed by Centers for Medicare and Medicaid Services. The purpose of this study was to identify both preoperative and postoperative reasons for readmission within 30 days following primary total hip and total knee arthroplasty (TKA).
Retrospective data were collected for patients who underwent elective primary total hip arthroplasty (THA; CPT code 27130) and TKA (27447) from 2008 to 2013 at our institution. The sample was separated into readmitted and nonreadmitted cohorts. Demography, comorbidities, Charlson comorbidity index (CCI), operative parameters, readmission rates, and causes of readmission were compared between the groups using univariate and multivariate regression analysis.
There were 42 (3.4%) and 28 (2.2%) readmissions within 30 days for THA and TKA, respectively. The most common cause of readmission within 30 days following total joint arthroplasty was infection. Trauma was the second most common reason for readmission of a THA while wound dehiscence was the second most common cause for readmission following TKA. With univariate regression, there were multiple associated factors for readmission among THA and TKA patients, including body mass index, metabolic equivalent (MET), and CCI. Multivariate regression revealed that hospital length of stay was significantly associated with 30-day readmission after THA and TKA.
Patient comorbidities and preoperative functional capacity significantly affect 30-day readmission rate following total joint arthroplasty. Adjustments for these parameters should be considered and we recommend the use of CCI and METs in risk adjustment models that use 30-day readmission as a marker for quality of patient care.
Level III/Retrospective cohort study.
由于医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）实施的经济处罚，在美国，许多医院都密切关注全关节置换术后的再入院率，这一指标已成为一个重要的关注点。本研究旨在确定初次全髋关节置换术（total hip arthroplasty，THA）和全膝关节置换术（total knee arthroplasty，TKA）后 30 天内再入院的术前和术后原因。
本研究回顾性收集了 2008 年至 2013 年在我院行择期初次 THA（CPT 代码 27130）和 TKA（27447）患者的资料。将患者分为再入院组和未再入院组。通过单变量和多变量回归分析比较两组患者的人口统计学资料、合并症、Charlson 合并症指数（Charlson comorbidity index，CCI）、手术参数、再入院率和再入院原因。
THA 和 TKA 的 30 天内再入院率分别为 3.4%（42 例）和 2.2%（28 例）。全关节置换术后 30 天内再入院的最常见原因是感染。创伤是 THA 再入院的第二大常见原因，而 TKA 再入院的第二大常见原因是伤口裂开。单变量回归分析显示，THA 和 TKA 患者再入院的相关因素有多种，包括体重指数、代谢当量（metabolic equivalent，MET）和 CCI。多变量回归分析显示，THA 和 TKA 患者的住院时间与 30 天内再入院显著相关。
患者的合并症和术前功能状态显著影响全关节置换术后 30 天内的再入院率。应该考虑这些参数的调整，我们建议在使用 30 天再入院作为患者护理质量的标志的风险调整模型中使用 CCI 和 MET。
III 级/回顾性队列研究。
