Dundon John, Koss Justin, Hodapp Kathleen, Lefevre Charmaine, Poletick Eileen, Patel Jay N
Orthopedic Surgery, Orthopedic Institute of New Jersey, Morristown, USA.
College of Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA.
Cureus. 2023 Feb 22;15(2):e35313. doi: 10.7759/cureus.35313. eCollection 2023 Feb.
Background Total joint arthroplasty (TJA) has moved to a value-based care model that emphasizes increased quality and decreased costs. Preoperative patient selection and optimization significantly improve postoperative outcomes, improve quality, and decrease systemic costs. We introduced a readmission risk assessment tool (RRAT) previously verified in the literature at a large, private practice, multispecialty hospital to determine if implementation could improve outcomes and decrease our readmission rates. Methods All patients were administered the RRAT scoring tool prior to surgery. All staff was trained prior by a team consisting of multiple orthopedic surgeons, internal medicine and cardiac specialists, and anesthesiologists. If the score received by the patient was greater or equal to 4, a letter was sent immediately to the operative physician to work on optimization and a list of options for optimization was provided. No patients were expressly denied surgery. Results All 4912 patients from September 2017 to March 2020 were screened using the RRAT tool. A total of 228 patients had an RRAT score greater than 4 and required notification of the index surgeon. The overall readmission rate was 2.61% for all patients. We noted a readmission rate of 2.35% for those with a score of <4, 4.27% for those between 4-6, and 13.64% for those with a readmission rate >6. The odds ratio of those readmitted with an RRAT score >6 was 6.5488 (1.9080-22.4775, 95% CI). The American Society of Anesthesiologists (ASA) score and RRAT score were significantly correlated (Spearman Rho =0.324, P<0.001). Thirty-day readmission rates across the system decreased from 3.7% to 2.61% (p<0.05) when compared to the readmission rate in the year prior to the application of RRAT (September 2016 - August 2017). Conclusion The preoperative RRAT score is significantly correlated with 30-day readmission rates. Notification of the surgeon preoperatively of risk factors with modification options significantly lowered readmission rates in our study. Preoperative optimization leads to a decreased readmission rate and surgeon involvement is paramount to adherence.
背景 全关节置换术（TJA）已转向以价值为基础的护理模式，该模式强调提高质量和降低成本。术前患者的选择和优化可显著改善术后结果、提高质量并降低总体成本。我们在一家大型私立多专科医院引入了一种先前在文献中得到验证的再入院风险评估工具（RRAT），以确定其实施是否能改善结果并降低我们的再入院率。方法 所有患者在手术前均接受RRAT评分工具评估。所有工作人员之前均由包括多名骨科医生、内科和心脏科专家以及麻醉师组成的团队进行培训。如果患者的得分大于或等于4，会立即向手术医生发送一封信，要求其进行优化，并提供优化选项列表。没有患者被明确拒绝手术。结果 对2017年9月至2020年3月期间的4912例患者全部使用RRAT工具进行筛查。共有228例患者的RRAT得分大于4，需要通知主刀医生。所有患者的总体再入院率为2.61%。我们注意到，得分<4的患者再入院率为2.35%，得分在4 - 6之间的患者为4.27%，得分>6的患者再入院率为13.64%。RRAT得分>6的患者再入院的比值比为6.5488（1.9080 - 22.4775，95%置信区间）。美国麻醉医师协会（ASA）评分与RRAT评分显著相关（Spearman Rho = 0.324，P<0.001）。与应用RRAT之前的年份（2016年9月 - 2017年8月）的再入院率相比，整个系统的30天再入院率从3.7%降至2.61%（p<0.05）。结论 术前RRAT评分与30天再入院率显著相关。在术前将危险因素及修改选项告知外科医生，在我们的研究中显著降低了再入院率。术前优化可降低再入院率，外科医生的参与对于依从性至关重要。
