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Risk Factors Predict Increased Length of Stay and Readmission Rates in Revision Joint Arthroplasty

Abstract Background This study aimed to identify risk factors for 30-day readmission and extended length of stay (LOS) in revision total knee (RKA) and hip (RHA) arthroplasty patients. Methods Patients who underwent RKA or RHA from 2011 to 2013 were identified in the National Surgical Quality Improv...

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Published in:The Journal of arthroplasty 2016-03, Vol.31 (3), p.603-608
Main Authors: Keswani, Aakash, BA, Lovy, Andrew J., MD, MS, Robinson, John, MD, Levy, Roger, MD, Chen, Darwin, MD, Moucha, Calin S., MD
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container_start_page 603
container_title The Journal of arthroplasty
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creator Keswani, Aakash, BA
Lovy, Andrew J., MD, MS
Robinson, John, MD
Levy, Roger, MD
Chen, Darwin, MD
Moucha, Calin S., MD
description Abstract Background This study aimed to identify risk factors for 30-day readmission and extended length of stay (LOS) in revision total knee (RKA) and hip (RHA) arthroplasty patients. Methods Patients who underwent RKA or RHA from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses of risk factors for 30-day readmission and extended LOS (>75th percentile) were assessed using preoperative and intraoperative variables. Results A total of 4977 RKA and 5135 RHA patients were reviewed. The most common causes for revision were mechanical (52% RKA, 52% RHA), infection (13% RKA, 8% RHA), dislocation (6% RKA, 13% RHA), and fracture (1% RKA, 4% RHA). Rate of readmission for RKA patients (6.4%; 318 patients) was lower than for RHA patients (8.0%; 409 patients) ( P = .002). Multivariate analysis identified severe adverse event before discharge, male sex, pulmonary disease, stroke, cardiac disease, and American Society of Anesthesiologists class 3 or 4 as significant predictors of readmission (all P ≤ .03). Surgical complications were the more common cause of readmission for both groups. Multivariate analysis of extended LOS identified infection or fracture etiology relative to mechanical loosening etiology, functional status, body mass index greater than 40 kg/m2, history of smoking, diabetes, cardiac disease, stroke, bleeding-causing disorders, wound class 3 or 4, and American Society of Anesthesiologists class 3 or 4 (all P ≤ .05) as independent predictors. Conclusion Modifiable risk factors should be addressed prior to revision total joint arthroplasty to reduce 30-day readmissions and LOS. Future P4P revision arthroplasty models should incorporate procedural diagnosis as rates of readmission and extended LOS significantly differ across procedural etiologies.
doi_str_mv 10.1016/j.arth.2015.09.050
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Methods Patients who underwent RKA or RHA from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses of risk factors for 30-day readmission and extended LOS (&gt;75th percentile) were assessed using preoperative and intraoperative variables. Results A total of 4977 RKA and 5135 RHA patients were reviewed. The most common causes for revision were mechanical (52% RKA, 52% RHA), infection (13% RKA, 8% RHA), dislocation (6% RKA, 13% RHA), and fracture (1% RKA, 4% RHA). Rate of readmission for RKA patients (6.4%; 318 patients) was lower than for RHA patients (8.0%; 409 patients) ( P = .002). Multivariate analysis identified severe adverse event before discharge, male sex, pulmonary disease, stroke, cardiac disease, and American Society of Anesthesiologists class 3 or 4 as significant predictors of readmission (all P ≤ .03). Surgical complications were the more common cause of readmission for both groups. Multivariate analysis of extended LOS identified infection or fracture etiology relative to mechanical loosening etiology, functional status, body mass index greater than 40 kg/m2, history of smoking, diabetes, cardiac disease, stroke, bleeding-causing disorders, wound class 3 or 4, and American Society of Anesthesiologists class 3 or 4 (all P ≤ .05) as independent predictors. Conclusion Modifiable risk factors should be addressed prior to revision total joint arthroplasty to reduce 30-day readmissions and LOS. Future P4P revision arthroplasty models should incorporate procedural diagnosis as rates of readmission and extended LOS significantly differ across procedural etiologies.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2015.09.050</identifier><identifier>PMID: 26601636</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Arthroplasty, Replacement, Hip - adverse effects ; Arthroplasty, Replacement, Knee - adverse effects ; Body Mass Index ; complications ; Databases, Factual ; Diabetes Complications ; Female ; Heart Diseases - complications ; Hemorrhage ; Humans ; length of stay ; Length of Stay - statistics &amp; numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Orthopedics ; Patient Readmission - statistics &amp; numerical data ; Quality Improvement ; readmission ; Reoperation - adverse effects ; Retrospective Studies ; revision hip arthroplasty ; revision knee arthroplasty ; Risk Factors ; Smoking ; Stroke - complications</subject><ispartof>The Journal of arthroplasty, 2016-03, Vol.31 (3), p.603-608</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-51dd53bf524d7297820572f622d35c73dc7845759eb3b403c10b393d672148103</citedby><cites>FETCH-LOGICAL-c481t-51dd53bf524d7297820572f622d35c73dc7845759eb3b403c10b393d672148103</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26601636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Keswani, Aakash, BA</creatorcontrib><creatorcontrib>Lovy, Andrew J., MD, MS</creatorcontrib><creatorcontrib>Robinson, John, MD</creatorcontrib><creatorcontrib>Levy, Roger, MD</creatorcontrib><creatorcontrib>Chen, Darwin, MD</creatorcontrib><creatorcontrib>Moucha, Calin S., MD</creatorcontrib><title>Risk Factors Predict Increased Length of Stay and Readmission Rates in Revision Joint Arthroplasty</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>Abstract Background This study aimed to identify risk factors for 30-day readmission and extended length of stay (LOS) in revision total knee (RKA) and hip (RHA) arthroplasty patients. Methods Patients who underwent RKA or RHA from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses of risk factors for 30-day readmission and extended LOS (&gt;75th percentile) were assessed using preoperative and intraoperative variables. Results A total of 4977 RKA and 5135 RHA patients were reviewed. The most common causes for revision were mechanical (52% RKA, 52% RHA), infection (13% RKA, 8% RHA), dislocation (6% RKA, 13% RHA), and fracture (1% RKA, 4% RHA). Rate of readmission for RKA patients (6.4%; 318 patients) was lower than for RHA patients (8.0%; 409 patients) ( P = .002). Multivariate analysis identified severe adverse event before discharge, male sex, pulmonary disease, stroke, cardiac disease, and American Society of Anesthesiologists class 3 or 4 as significant predictors of readmission (all P ≤ .03). Surgical complications were the more common cause of readmission for both groups. Multivariate analysis of extended LOS identified infection or fracture etiology relative to mechanical loosening etiology, functional status, body mass index greater than 40 kg/m2, history of smoking, diabetes, cardiac disease, stroke, bleeding-causing disorders, wound class 3 or 4, and American Society of Anesthesiologists class 3 or 4 (all P ≤ .05) as independent predictors. Conclusion Modifiable risk factors should be addressed prior to revision total joint arthroplasty to reduce 30-day readmissions and LOS. Future P4P revision arthroplasty models should incorporate procedural diagnosis as rates of readmission and extended LOS significantly differ across procedural etiologies.</description><subject>Adult</subject><subject>Aged</subject><subject>Arthroplasty, Replacement, Hip - adverse effects</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Body Mass Index</subject><subject>complications</subject><subject>Databases, Factual</subject><subject>Diabetes Complications</subject><subject>Female</subject><subject>Heart Diseases - complications</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>length of stay</subject><subject>Length of Stay - statistics &amp; numerical data</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Orthopedics</subject><subject>Patient Readmission - statistics &amp; numerical data</subject><subject>Quality Improvement</subject><subject>readmission</subject><subject>Reoperation - adverse effects</subject><subject>Retrospective Studies</subject><subject>revision hip arthroplasty</subject><subject>revision knee arthroplasty</subject><subject>Risk Factors</subject><subject>Smoking</subject><subject>Stroke - complications</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9kU9v1DAQxS0EokvhC3BAPnJJ8J_YTiSEVFUtFK0E2sLZcuwJ9TZrL7a30n57HLZw4MDJ49F7TzO_Qeg1JS0lVL7btiaVu5YRKloytESQJ2hFBWdN3xH5FK1I3_NGdISfoRc5bwmhVIjuOTpjUtYALldo3Ph8j6-NLTFl_DWB87bgm2ATmAwOryH8KHc4Tvi2mCM2weENGLfzOfsY8MYUyNjXAh78787n6EPBF3WwFPezyeX4Ej2bzJzh1eN7jr5fX327_NSsv3y8ubxYN7braWkEdU7wcRKsc4oNqmdEKDZJxhwXVnFnVd8JJQYY-Vh3spSMfOBOKkZrAOHn6O0pd5_izwPkouuUFubZBIiHrKmSSjJO-65K2UlqU8w5waT3ye9MOmpK9MJWb_XCVi9sNRl0ZVtNbx7zD-MO3F_LH5hV8P4kgLrlg4eks_UQbGWawBbtov9__od_7Hb2wVsz38MR8jYeUqj8NNWZaaJvl-sux6WC1LJ-fgFmVJ4t</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Keswani, Aakash, BA</creator><creator>Lovy, Andrew J., MD, MS</creator><creator>Robinson, John, MD</creator><creator>Levy, Roger, MD</creator><creator>Chen, Darwin, MD</creator><creator>Moucha, Calin S., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160301</creationdate><title>Risk Factors Predict Increased Length of Stay and Readmission Rates in Revision Joint Arthroplasty</title><author>Keswani, Aakash, BA ; Lovy, Andrew J., MD, MS ; Robinson, John, MD ; Levy, Roger, MD ; Chen, Darwin, MD ; Moucha, Calin S., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-51dd53bf524d7297820572f622d35c73dc7845759eb3b403c10b393d672148103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Arthroplasty, Replacement, Hip - adverse effects</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Body Mass Index</topic><topic>complications</topic><topic>Databases, Factual</topic><topic>Diabetes Complications</topic><topic>Female</topic><topic>Heart Diseases - complications</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>length of stay</topic><topic>Length of Stay - statistics &amp; numerical data</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Orthopedics</topic><topic>Patient Readmission - statistics &amp; numerical data</topic><topic>Quality Improvement</topic><topic>readmission</topic><topic>Reoperation - adverse effects</topic><topic>Retrospective Studies</topic><topic>revision hip arthroplasty</topic><topic>revision knee arthroplasty</topic><topic>Risk Factors</topic><topic>Smoking</topic><topic>Stroke - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Keswani, Aakash, BA</creatorcontrib><creatorcontrib>Lovy, Andrew J., MD, MS</creatorcontrib><creatorcontrib>Robinson, John, MD</creatorcontrib><creatorcontrib>Levy, Roger, MD</creatorcontrib><creatorcontrib>Chen, Darwin, MD</creatorcontrib><creatorcontrib>Moucha, Calin S., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Keswani, Aakash, BA</au><au>Lovy, Andrew J., MD, MS</au><au>Robinson, John, MD</au><au>Levy, Roger, MD</au><au>Chen, Darwin, MD</au><au>Moucha, Calin S., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors Predict Increased Length of Stay and Readmission Rates in Revision Joint Arthroplasty</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>31</volume><issue>3</issue><spage>603</spage><epage>608</epage><pages>603-608</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>Abstract Background This study aimed to identify risk factors for 30-day readmission and extended length of stay (LOS) in revision total knee (RKA) and hip (RHA) arthroplasty patients. Methods Patients who underwent RKA or RHA from 2011 to 2013 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses of risk factors for 30-day readmission and extended LOS (&gt;75th percentile) were assessed using preoperative and intraoperative variables. Results A total of 4977 RKA and 5135 RHA patients were reviewed. The most common causes for revision were mechanical (52% RKA, 52% RHA), infection (13% RKA, 8% RHA), dislocation (6% RKA, 13% RHA), and fracture (1% RKA, 4% RHA). Rate of readmission for RKA patients (6.4%; 318 patients) was lower than for RHA patients (8.0%; 409 patients) ( P = .002). Multivariate analysis identified severe adverse event before discharge, male sex, pulmonary disease, stroke, cardiac disease, and American Society of Anesthesiologists class 3 or 4 as significant predictors of readmission (all P ≤ .03). Surgical complications were the more common cause of readmission for both groups. Multivariate analysis of extended LOS identified infection or fracture etiology relative to mechanical loosening etiology, functional status, body mass index greater than 40 kg/m2, history of smoking, diabetes, cardiac disease, stroke, bleeding-causing disorders, wound class 3 or 4, and American Society of Anesthesiologists class 3 or 4 (all P ≤ .05) as independent predictors. Conclusion Modifiable risk factors should be addressed prior to revision total joint arthroplasty to reduce 30-day readmissions and LOS. Future P4P revision arthroplasty models should incorporate procedural diagnosis as rates of readmission and extended LOS significantly differ across procedural etiologies.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26601636</pmid><doi>10.1016/j.arth.2015.09.050</doi><tpages>6</tpages></addata></record>
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source Elsevier
subjects Adult
Aged
Arthroplasty, Replacement, Hip - adverse effects
Arthroplasty, Replacement, Knee - adverse effects
Body Mass Index
complications
Databases, Factual
Diabetes Complications
Female
Heart Diseases - complications
Hemorrhage
Humans
length of stay
Length of Stay - statistics & numerical data
Male
Middle Aged
Multivariate Analysis
Orthopedics
Patient Readmission - statistics & numerical data
Quality Improvement
readmission
Reoperation - adverse effects
Retrospective Studies
revision hip arthroplasty
revision knee arthroplasty
Risk Factors
Smoking
Stroke - complications
title Risk Factors Predict Increased Length of Stay and Readmission Rates in Revision Joint Arthroplasty
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