Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

Yian, Edward H.; Zhou, Hui; Schreiber, Ariyon; Sodl, Jeff; Navarro, Ronald A.; Singh, Anshuman; Bezrukov, Nikita

doi:10.7812/tpp/15-065

Cited by 17 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Outside the field of transplantation, readmission is a well-understood risk factor for mortality following surgery. Following various surgical procedures, including pancreatectomy, coronary artery bypass grafting, orthopedic repairs, colectomy, esophagectomy, and lung cancer resection, EHR is associated with a 2.3 to 6.6-fold increase in the risk of mortality (2, 3, 4, 8–11, 15). Interestingly, studies with longer follow-up have a lower estimated risk ratio, indicating the effect may be a partial artifact of study design and follow-up time.…”

Section: Discussionmentioning

confidence: 99%

“…In other words, the risk of graft loss and death for recipients who are acutely ill and readmitted to the hospital is considered the same as the risk for recipients who experienced EHR in the past, survived that readmission, and are currently months or years postreadmission. Prior work in transplantation, and other fields, assumes that the risk associated with EHR is constant over time without considering the possibility that it may vary with time (2, 3–11). In particular, the association between EHR and adverse transplant outcomes may be substantially different for KT recipients that are in the hospital experiencing EHR and those that have previously experienced EHR.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Mortality and Graft Loss Attributable to Readmission After Kidney Transplantation

King¹,

Bowring

Massie³

et al. 2017

Transplantation

View full text Add to dashboard Cite

Background Following kidney transplantation, early readmission is independently associated with graft loss and mortality. The mechanism of this association is poorly understood. Understanding the timeline of risk, ie, during the readmission hospitalization versus time periods postreadmission, will provide additional insights. Methods We used national registry data to study 56,076 adult Medicare-primary first-time kidney transplant recipients from December 1999–October 2011. Piecewise Cox proportional hazard models were used to estimate the association between graft loss, mortality, and readmission for two time periods: readmission hospitalization and postreadmission. Results During the readmission hospitalization, graft loss was substantially higher (deceased donor (DDKT) without delayed graft function (DGF) hazard ratio: 24.634.447.9, p<0.001; with DGF: 10.815.221.4, p<0.001; live donor (LDKT): 18.136.774.2, p<0.001) and mortality was substantially higher (DDKT without DGF: 14.120.830.7, p<0.001; with DGF: 9.0312.818.0, p<0.001; LDKT: 9.0018.241.3, p<0.001). Immediately following readmission discharge, graft loss (DDKT without DGF: 2.082.402.77, p<0.001; with DGF: 1.832.142.51, p<0.001; LDKT: 2.002.503.13, p<0.001) and mortality (DDKT without DGF: 2.162.432.73, p<0.001; with DGF: 1.832.162.88, p<0.001; LDKT: 1.902.342.88, p<0.001) remained elevated, but much less so. Following readmission, the hazard of graft loss remained, but decreased 19% per year for DDKT recipients (time varying coefficient 0.780.810.85, p<0.001) and 14% per year for LDKT recipients (0.790.860.93, p<0.001). The hazard of mortality remained, but decreased 14% per year for DDKT recipients (0.830.860.89, p<0.001) and 9% per year for LDKT recipients (0.850.910.98, p<0.001). Conclusions In conclusion, readmission is most strongly associated with graft loss and mortality during the readmission hospitalization, but also portends a lasting, albeit attenuated, risk postreadmission.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mortality and Graft Loss Attributable to Readmission After Kidney Transplantation

King¹,

Bowring

Massie³

et al. 2017

Transplantation

View full text Add to dashboard Cite

show abstract

“… 5 - 8 One-year mortality after PHFs, treated conservatively or surgically, was found to be between 5% and 22%. 5 , 9 - 11 An increase in 1-year mortality was also observed in other fragility fractures, and in hip fractures, 1-year mortality is as high as 40%. 5 , 12 , 13 In the case of hip fractures, the current paradigm is that urgent surgical treatment reduces mortality by allowing early mobilization, though this was not demonstrated in randomized clinical trials.…”

Section: Introductionmentioning

confidence: 91%

Mortality After Complex Displaced Proximal Humerus Fractures in Elderly Patients: Conservative Versus Operative Treatment With Reverse Total Shoulder Arthroplasty

Rotman

Giladi

Senderey

et al. 2018

Geriatr Orthop Surg Rehabil

View full text Add to dashboard Cite

Introduction:Proximal humerus fractures (PHFs) are a common fragility fracture and have been shown to increase mortality in elderly patients. In the last decade, reverse total shoulder arthroplasty (RTSA) was introduced as a reliable operative treatment option for this indication. In other fragility fractures, most notably hip fractures, urgent surgical treatment can reduce mortality. The purpose of this study is to evaluate whether treatment with RTSA can reduce 1-year mortality in elderly patients with complex displaced PHFs.Materials and Methods:A retrospective study was performed to compare 1-year mortality between 2 groups of elderly patients (>75 years old) who presented to a level 1 trauma center emergency department with complex displaced PHFs. The conservative treatment group (n = 83; mean age, 83.7 years) presented from 2008 to 2010 when RTSA was not yet available, and treatment was nonoperative. The surgical treatment group (n = 62; mean age, 82.2 years) presented from 2012 to 2015 and underwent RTSA.Results:One-year mortality was 8.1% (male 7.1%; female 8.3%) in the surgical treatment group and 10.8% (male 18.8%; female 9.0%) in the conservative treatment group. The reduction in mortality in the surgical treatment group was not significant (entire cohort P = .56; males P = .35; females P = .59).Discussion:Recent studies failed to show better functional results after surgical treatment with RTSA when compared to conservative treatment. This study suggests that a benefit of surgical treatment with RTSA that was not examined until now might exist—a reduction in the increased mortality risk associated with PHFs.Conclusions:There was no significant difference in 1-year mortality between the groups, although there was a trend showing lower mortality with RTSA, mostly in men. Further studies with larger populations and longer follow-up times are needed to determine whether this trend is of clinical significance.

show abstract

“…Hospital readmissions within 30 days post-hospital discharges (i.e., 30-day readmissions) have become an important measure of health care quality due to the high 30-day readmission rates among US Medicare beneficiaries [ 22 ]. Evidence suggests that 30-day readmissions are a significant predictor of long-term mortality [ 23 ]. In order to reduce 30-day readmission rates, the Centers for Medicare and Medicaid Services implemented the Medicare Hospital Readmissions Reduction Program which, as a penalty, reduces Medicare payments to hospitals with excess 30-day readmissions relative to the mean national readmission rates in conditions such as acute myocardial infarction and heart failure [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis

et al. 2017

View full text Add to dashboard Cite

BackgroundSerious mental illnesses are associated with increased risk of cardiometabolic comorbidities. The objective of this study was to evaluate the prevalence of cardiometabolic comorbidity and its association with hospitalization outcomes and costs among inpatients with schizophrenia or bipolar disorder.MethodsThis retrospective database analysis reviewed patients with an inpatient diagnosis of schizophrenia or bipolar disorder from the Premier Perspective® Database (4/1/2010–6/30/2012). Patients were categorized into 4 cohorts based on the number of ICD-9-CM cardiometabolic comorbidities (i.e., 0, 1, 2, or 3+). Outcomes included length of stay, mortality during the index hospitalization, healthcare costs, and 30-day all-cause readmission rates.ResultsOf 57,506 patients with schizophrenia, 66.1% had at least one cardiometabolic comorbidity; 39.3% had two or more comorbidities. Of 124,803 patients with bipolar disorder, 60.5% had at least one cardiometabolic comorbidity; 33.4% had two or more. Average length of stay was 8.5 (for patients with schizophrenia) and 5.2 (for patients with bipolar disorder) days. Each additional cardiometabolic comorbidity was associated with an increase in length of stay for patients with bipolar disorder (p < .001) but not for patients with schizophrenia. Mortality rates during the index hospitalization were 1.2% (schizophrenia) and .7% (bipolar disorder). Each additional cardiometabolic comorbidity was associated with a significant increase in mortality for patients with bipolar disorder (OR 1.218, p < .001), and a numerical increase in mortality for patients with schizophrenia (OR 1.014, p = .727). Patients with more cardiometabolic comorbidities were more likely to have a 30-day readmission (schizophrenia = 9–13%; bipolar disorder = 7–12%), and to incur higher costs (schizophrenia = $10,606–15,355; bipolar disorder = $7126–13,523) (all p < .01).ConclusionsOver 60% of inpatients with schizophrenia or bipolar disorder had cardiometabolic comorbidities. Greater cardiometabolic comorbidity burden was associated with an increased likelihood of readmission and higher costs among patients with schizophrenia or bipolar disorder, and an increase in length of stay and mortality for patients with bipolar disorder.

show abstract

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

Cited by 17 publications

References 29 publications

Mortality and Graft Loss Attributable to Readmission After Kidney Transplantation

Mortality and Graft Loss Attributable to Readmission After Kidney Transplantation

Mortality After Complex Displaced Proximal Humerus Fractures in Elderly Patients: Conservative Versus Operative Treatment With Reverse Total Shoulder Arthroplasty

Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis

Contact Info

Product

Resources

About