Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases

Westermann, Robert W.; Pugely, Andrew J.; Ries, Zachary; Amendola, Annunziato; Martin, Christopher T.; Gao, Yubo; Wolf, Brian R.

doi:10.1016/j.arthro.2015.03.029

Cited by 66 publications

(56 citation statements)

References 21 publications

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“…Hypertension was also identified in the present study as a comorbid condition associated with readmission, which had not previously been associated with readmissions in the arthroscopic population. 9,14 The increased complexity of managing of these comorbidities during the perioperative period is likely to influence the risk for complications and hospital readmission. Unsurprisingly, ASA classification was strongly correlated as a risk factor for readmission as this score is closely related to a patient's comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Analyzing both knee and shoulder arthroscopy patients together, a recent study utilizing ACS-NSQIP data identified chronic steroid use, American Society of Anesthesiologists (ASA) class, and age as risk factors for readmission in arthroscopy. 14 Additionally, a study of adverse events following arthroscopic meniscectomy found ASA class and smoking increased odds of readmission, but concluded that age was not a significant predictor of readmissions. 5 Thus, it is important to investigate readmissions following specifically knee arthroscopy and more clearly elucidate the significance of risk factors, such as age.…”

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confidence: 99%

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Risk Factors for 30-Day Readmission following Knee Arthroscopy

et al. 2019

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This study evaluates knee arthroscopy cases in a national surgical database to identify risk factors associated with readmission. The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2016 for billing codes related to knee arthroscopy. International Classification of Diseases diagnostic codes were then used to exclude cases which involved infection. Patients were subsequently reviewed for readmission within 30 days. Univariate and multivariate analyses were then performed to identify risk factors associated with 30-day readmission. A total of 69,022 patients underwent knee arthroscopy. The overall 30-day complication rate was 1.75% and the 30-day readmission rate was 0.92%. On multivariate analysis, age > 60 years (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.07–1.55), smoking (OR, 1.40; 95% CI, 1.15–1.70), recent weight loss (OR, 13.22; 95% CI, 5.03–34.73), chronic obstructive pulmonary disease (OR, 1.98; 95% CI, 1.39–2.82), hypertension (OR, 1.48; 95% CI, 1.23–1.78), diabetes (OR, 1.92; 95% CI, 1.40–2.64), renal failure (OR, 10.65; 95% CI, 2.90–39.07), steroid use within 30 days prior to the procedure (OR, 1.91; 95% CI, 1.24–2.94), American Society of Anesthesiologists (ASA) class ≥ 3 (OR, 1.69; 95% CI, 1.40–2.04), and operative time > 45 minutes (OR, 1.68; 95% CI, 1.42–2.00) were identified as independent risk factors for readmission. These findings confirm that the 30-day overall complication (1.75%) and readmission rates (0.92%) are low for knee arthroscopy procedures; however, age > 60 years, smoking status, recent weight loss, chronic obstructive pulmonary disease, hypertension, diabetes, chronic steroid use, ASA class ≥ 3, and operative time > 45 minutes are independent risk factors for readmission.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Risk Factors for 30-Day Readmission following Knee Arthroscopy

et al. 2019

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“…The most common causes for readmission were surgery related, such as infection and thromboembolic events. 15 Independent risk factors for readmission have been shown to include age, chronic steroid use, and American Society of Anesthesiologists classification status. 15 Despite the value of these studies to the management of ACL patients, they are limited by the use of a single database or registry, which limits event capture.…”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery

Liu

Kim

Maalouf

et al. 2018

Regional Anesthesia and Pain Medicine

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The rate of hospital-based acute care following outpatient ACL surgery was 3.90%. Many of the events were expected complications related to surgery, such as infection and deep venous thrombosis. However, musculoskeletal pain, drug abuse, and psychotic events featured more prominently than expected. Our findings may direct efforts to address these reasons for seeking acute care after ACL surgery, reduce cost, and improve quality of care.

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“…The ACS NSQIP database has been well accepted in the orthopedic literature, and general methodology has been previously described. 16,17 In brief, this clinical registry contains cases from both academic and private medical institutions. Prospective preoperative and operative data, as well as 30-day outcomes, were collected from nearly 500 hospitals across the United States.…”

Section: Methodsmentioning

confidence: 99%

Infection following Anterior Cruciate Ligament Reconstruction: An Analysis of 6,389 Cases

et al. 2016

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Infection following anterior cruciate ligament reconstruction (ACLR) is rare. Previous authors have concluded that diabetes, tobacco use, and previous knee surgery may influence infection rates following ACLR. The purpose of this study was to identify a cohort of patients undergoing ACLR and define (1) the incidence of infection after ACLR from a large multicenter database and (2) the risk factors for infection after ACLR. We identified patients undergoing elective ACLRs in the American College of Surgeons National Surgical Quality Improvement Program database between 2007 and 2013. The primary outcome was any surgical site infection within 30 days of surgery. We performed univariate and multivariate analyses comparing infected and noninfected cases to identify risk factors for infection. In total, 6,398 ACLRs were available for analysis of which 39 (0.61%) were diagnosed with a postoperative infection. Univariate analysis identified preoperative dyspnea, low hematocrit, operative time > 1 hour, and hospital admission following surgery as predictors of postoperative infection. Diabetes, tobacco use, age, and body mass index (BMI) were not associated with infection ( > 0.05). After multivariate analysis, the only independent predictor of postoperative infection was hospital admission following surgery (odds ratio, 2.67; 95% confidence interval, 1.02-6.96; = 0.04). Hospital admission following surgery was associated with an increased incidence of infection in this large, multicenter cohort. Smoking, elevated BMI, and diabetes did not increase the risk infection in the present study. Surgeons should optimize outpatient operating systems and practices to aid in same-day discharges following ACLR.

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Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases

Cited by 66 publications

References 21 publications

Risk Factors for 30-Day Readmission following Knee Arthroscopy

Risk Factors for 30-Day Readmission following Knee Arthroscopy

Thirty-Day Acute Health Care Resource Utilization Following Outpatient Anterior Cruciate Ligament Surgery

Infection following Anterior Cruciate Ligament Reconstruction: An Analysis of 6,389 Cases

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