Hospital Readmissions After Surgical Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

Abstract

Background With technologic advances such as locked periarticular plating, hemiarthroplasty of the humeral head, and more recently reverse total shoulder replacement, surgical treatment of proximal humerus fractures has become more commonplace. However, there is insufficient information regarding patient outcomes after surgery, such as the frequency of unplanned hospital readmissions and factors contributing to readmission. Questions/purposes We measured (1) the frequency of unplanned hospital readmissions after surgical treatment of proximal humerus fractures, (2) the medical and surgical causes of readmission, and (3) the risk factors associated with unplanned readmissions. Methods The State Inpatient Database from seven different states was used to identify patients who underwent treatment for a proximal humerus fracture with open reduction and internal fixation (ORIF), hemiarthroplasty of the humeral head, or reverse total shoulder arthroplasty from 2005 through 2010. The database was used to measure the 30-day and 90-day readmission rates and identify causes and risk factors for readmission. Multivariate modeling and a Cox proportional hazards model were used for statistical analysis. Results A total of 27,017 patients were included with an overall 90-day readmission rate of 14% (15% for treatment with ORIF, 15% for reverse total shoulder arthroplasty, and 13% for hemiarthroplasty). The majority of readmissions were associated with medical diagnoses (75%), but treatment with ORIF was associated with the most readmissions from surgical complications, (29%) followed by reverse total shoulder arthroplasty (20%) and hemiarthroplasty (16%) (p \ 0.001). Risk of readmission was greater for patients who were female, African American, discharged to a nursing facility, or had Medicaid insurance. Conclusions As the majority of unplanned hospital readmissions were associated with medical diagnoses, it is important to consider patient medical comorbidities before surgical treatment of proximal humerus fractures and during the postoperative care phase. Level of Evidence Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Risk of Hospital Readmission Among Infants With Neonatal Abstinence Syndrome

“…13 These data have been used in previous studies evaluating trends in hospital readmissions among children 14 and adults. 15,16 We obtained data for live births in New York State from the New York Department of Health (http://www.health.ny.gov/statistics/vital_statistics/). Because the analysis was of de-identified data, it was considered exempt for human subjects review by the Vanderbilt University School of Medicine Institutional Review Board.…”

Predictors of Hospital Readmission After Total Shoulder Arthroplasty

“…The remaining preoperative demographic and surgical variables identified on univariate analysis were no longer significant on multivariate analysis after controlling for the influence of the remaining risk factors. In contrast, the role of patient factors and surgical characteristics in hospital readmission after TSA in single-state [24][25][26] or single-institution investigations 21 is limited because these studies did not provide the same level of detail on medical comorbidities, laboratory values, and surgical characteristics as the NSQIP data set. Additionally, the current study found no difference for factors previously shown to predict increased 60-to 90-day readmission rates after TSA, such as age, 25 race, 26 or increasing number of medical comorbidities.…”

“…Medical complications rather than surgical complications were responsible for most readmissions after TSA, and this finding corroborates previous studies that showed that 80% to 82% of complications leading to readmission after TSA were medical. 25,26 The identification of pertinent complications that contribute to hospital re- admission after primary TSA can lead to targeted interventions to mitigate these complications in high-risk patients during the perioperative period. In the absence of reliable evidence, the American Academy of Orthopaedic Surgeons offered a consensus statement advocating for perioperative mechanical or chemical venous thromboembolic prophylaxis for patients undergoing TSA.…”

“…Although factors that affect length of stay after TSA are well delineated, 20 literature on readmission after TSA is limited to either single-institution 21,22 or registry data. [23][24][25][26] Readmission rates after TSA have been reported at 4.5% to 6.0% at 90 days, 21,25 and rates are significantly lower than after total knee arthroplasty or total hip arthroplasty. 23 However, pre-and postoperative in-hospital patient characteristics that herald an increased likelihood of readmission are largely unexamined, with only 1 known retrospective, single-state registry exploring variables that predict readmission after TSA.…”

Surgical Management of 3 and 4-Part Proximal Humerus Fractures with Locking Plates in Elderly

“…The 40% of the complications are seems to be related to the incorrect surgical technique that is mostly related to the experience [4]. Because of high complication rates in 4-part fractures, some authors recommend hemiarthroplasty to avoid seconder surgery despite to lower functional outcomes than locking plates [16,25]. Patient's age negatively affects the functional results that are managed with osteosynthesis [6,[20][21][22].…”