Emergency Department Utilization After Elective Hip Arthroscopy

Sivasundaram, Lakshmanan; Trivedi, Nikunj N.; Kim, Chang-Yeon; Du, Jerry Y.; Liu, Raymond W.; Voos, James E.; Salata, Michael J.

doi:10.1016/j.arthro.2020.02.008

Cited by 31 publications

(32 citation statements)

References 29 publications

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“…Several investigations have used conventional statistical modeling to determine risk factors for inpatient admission after hip arthroscopy. 8,9,21,22 Du et al identified 1,931 patients who underwent hip arthroscopy and the rate of 30-day readmission following index procedure was estimated to be 0.9%. 8 Multivariate analysis identified increasing BMI, chronic corticosteroid use, and perioperative blood transfusions as independent risk factors associated with unplanned admission within 30 days after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Sivasundaram et al reported that increased operating room time was not a significant risk factor for postoperative emergency department use. 22 Two other investigations also using the NSQIP database demonstrated conflicting results regarding the role of operative time. 8,9 Du et al found that increased operative time was not significantly associated with 30-day unplanned admission.…”

Section: Discussionmentioning

confidence: 99%

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Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy

Song

Wilbur

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purposes of this study were to identify patient characteristics and risk factors for overnight admission following outpatient hip arthroscopy and to develop a machine learning algorithm that can effectively identify patients requiring admission following elective hip arthroscopy. Methods A retrospective review of a prospectively collected national surgical outcomes database was performed to identify patients who underwent elective outpatient hip arthroscopy from 2006 to 2018. Patients admitted overnight postoperatively were identified as those with length of stay of 1 or more days. Models were generated using random forest (RF), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the four final algorithms. Results Overall, 1,276 patients were included. The median age was 43 years, and 64.2% (819) were female. Of the included patients, 109 (8.5%) required an overnight stay following elective outpatient hip arthroscopy. The most important factors for inpatient admission were increasing operative time, general anesthesia, age extremes, male gender, greater body mass index (BMI), American Society of Anesthesiologists classification >1, and the following preoperative lab values outside of normal ranges: sodium, platelet count, hematocrit, and leukocyte count. The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = .71), calibration, and decision curve analysis. The model was integrated into a Web-based open-access application able to provide both personalized predictions and explanations. Conclusion A machine learning algorithm developed based on preoperative features identified increasing operative time, age extremes, greater BMI, sodium, hematocrit, platelets, and leukocyte count as the most important variables associated with inpatient admission with fair validity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy

Song

Wilbur

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

show abstract

“…The study by Sivasundaram et al 4 had several important limitations to recognize and consider. First, the databases used in the study were limited to hospitalbased ED visits and therefore excluded occasions where patients sought medical care with their surgeon in an outpatient clinic, urgent care facility, or with their primary care physicians.…”

Section: See Related Article On Page 1575mentioning

confidence: 97%

“…Sivasundaram et al 4 additionally found that 6.6% of patients sought ED evaluation within 90 days of surgery, with Medicare and Medicaid patients being at particularly high risk for seeking ED care in this timeframe. This highlights an important well-described finding in the literature, that patients with Medicaid are more likely to seek ED care because of numerous social barriers and access to health care.…”

Section: See Related Article On Page 1575mentioning

confidence: 98%

“…In their study "Emergency Department Utilization Following Elective Hip Arthroscopy," 4 Sivasundaram, Trivedi, Kim, Du, Liu, Voos, and Salata used large database registries to investigate the rate at which patients sought medical evaluation in emergency departments (ED) after hip arthroscopy. Prior studies have identified low 30-day readmission rates (0.5%-1.3%) following hip arthroscopy; however, as this study suggests, this may underestimate the rate at which these patients seek outpatient medical attention.…”

Section: See Related Article On Page 1575mentioning

confidence: 99%

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Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

Hartwell¹,

Tjong²

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Hip arthroscopy is known to be a relatively safe procedure with a limited and unique set complications and low hospital readmission rates. Many patients, however, may seek emergency department evaluation after surgery for postoperative pain or complaints unrelated to the most commonly cited complications, such as traction neuropraxia. It is important to recognize and understand the reasons why patients seek medical care after surgery because many of these encounters may be preventable with optimization of perioperative multimodal pain control regimens and proper patient education regarding their expected postoperative course. Patients with barriers to health care access, such as Medicare and Medicaid patients, may be at higher risk for emergency department evaluation of their problems after surgery and clinicians should consider providing additional counseling to these patients regarding when and how to seek medical evaluation after surgery.

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Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

Bovonratwet

Boddapati

Nwachukwu

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to determine the association between operative duration and short‐term complications as well as overnight hospital admission following hip arthroscopy. MethodsHip arthroscopy cases from 2006 to 2016 were retrieved from the National Surgical Quality Improvement Program registry, which prospectively collects 30‐day postoperative complications. Patients were stratified into the following groups based on procedure length: group 1 (< 60 min), group 2 (60–120 min), and group 3 (> 120 min). Preoperative characteristics were compared across the cohorts. Multivariate regressions were used to compare complication rates and overnight hospital admission between the three groups. Independent risk factors for overnight hospital admission were characterized. ResultsA total of 2129 hip arthroscopy cases were identified. Average operative duration was 99.3 ± 55.7 min. As operative time increased, patients were more likely to be younger, male, and had lower American Society of Anesthesiologists (ASA) class (p < 0.001). Body mass index and comorbidity profiles were similar across the patient cohorts, with the exception of hypertension being more prevalent in the shorter operative time cohort (p < 0.001). Patients in group 3 were more likely to stay overnight in the hospital (26.0%) compared to patients in groups 1 (7.7%) and 2 (10.9%), p < 0.001). All postoperative complication rates were otherwise similar between the cohorts. Independent risk factors for overnight hospital admission included increasing operative time (most notably > 120 min relative to < 60 min, relative risk [RR] = 3.53, 95% CI 2.50–5.00, p < 0.001) and increasing ASA classification (most notably ASA III or IV relative to ASA I, RR = 1.64, 95% CI 1.18–2.27; p = 0.013). ConclusionsIncreasing operative duration was not associated with increased postoperative complications following hip arthroscopy. However, patients were more than three times likely to stay in the hospital overnight if their surgery was longer than 120 min, relative to cases that were less than 60 min. Level of evidenceIII.

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Emergency Department Utilization After Elective Hip Arthroscopy

Cited by 31 publications

References 29 publications

Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy

Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

Increased hip arthroscopy operative duration is an independent risk factor for overnight hospital admission

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