Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Arthroplasty. 2021 May;36(5):1823-1831. doi: 10.1016/j.arth.2020.10.052. Epub 2020 Nov 3.
Predictive tools are useful adjuncts in surgical planning. They help guide patient selection, candidacy for inpatient vs outpatient surgery, and discharge disposition as well as predict the probability of readmissions and complications after total joint arthroplasty (TJA). Surgeons may find it difficult due to significant variation among risk calculators to decide which tool is best suited for a specific patient for optimal decision-based care. Our aim is to perform a systematic review of the literature to determine the existing post-TJA readmission calculators and compare the specific elements that comprise their formula. Second, we intend to evaluate the pros and cons of each calculator.
Using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols protocol, we conducted a systematic search through 3 major databases for publications addressing TJA risk stratification tools for readmission, discharge disposition, and early complications. We excluded those manuscripts that were not comprehensive for hips and knees, did not list discharge, readmission or complication as the primary outcome, or were published outside the North America.
Ten publications met our criteria and were compared on their sourced data, variable types, and overall algorithm quality. Seven of these were generated with single institution data and 3 from large administrative datasets. Three tools determined readmission risk, 5 calculated discharge disposition, and 2 predicted early complications. Only 4 prediction tools were validated by external studies. Seven studies utilized preoperative data points in their risk equations while 3 utilized intraoperative or postsurgical data to delineate risk.
The extensive variation among TJA risk calculators underscores the need for tools with more individualized stratification capabilities and verification. The transition to outpatient and same-day discharge TJA may preclude or change the need for many of these calculators. Further studies are needed to develop more streamlined risk calculator tools that predict readmission and surgical complications.
预测工具是手术规划中的有用辅助工具。它们有助于指导患者选择、确定住院或门诊手术的候选资格，以及出院处置，还可以预测全关节置换术后（TJA）的再入院率和并发症的概率。由于风险计算器之间存在显著差异，外科医生可能难以决定哪种工具最适合特定患者，以实现最佳基于决策的护理。我们的目的是对文献进行系统回顾，以确定现有的 TJA 再入院计算器，并比较其公式的具体要素。其次，我们打算评估每个计算器的优缺点。
使用系统评价和荟萃分析报告的首选报告项目协议，我们通过 3 个主要数据库对涉及 TJA 风险分层工具的出版物进行了系统搜索，这些工具用于再入院、出院处置和早期并发症。我们排除了那些不是针对臀部和膝盖的综合出版物，没有将出院、再入院或并发症列为主要结果，或者发表在北美以外的出版物。
有 10 篇出版物符合我们的标准，并对其来源数据、变量类型和整体算法质量进行了比较。其中 7 篇是基于单机构数据生成的，3 篇是基于大型行政数据集生成的。有 3 种工具用于确定再入院风险，5 种用于计算出院处置，2 种用于预测早期并发症。只有 4 种预测工具得到了外部研究的验证。7 项研究在风险方程中使用了术前数据点，而 3 项研究则使用了术中或术后数据来划定风险。
TJA 风险计算器之间的广泛差异强调了需要具有更多个体化分层能力和验证的工具。向门诊和当天出院的 TJA 的转变可能会排除或改变许多这些计算器的需求。需要进一步研究来开发更精简的风险计算器工具，以预测再入院和手术并发症。
