Incidence and Reason for Readmission and Unscheduled Health Care Contact After Distal Radius Fracture

Sumner, Kirsten; Grandizio, Louis C.; Gehrman, Max D.; Graham, Jove; Klena, Joel C.

doi:10.1177/1558944718788687

Cited by 10 publications

(18 citation statements)

References 23 publications

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“…Upon review of our institutional historical cohort, 22% of patients (n = 26 telephone calls, n = 20 urgent care/emergency department presentations, n = 4 both) either presented to the emergency department/ urgent care or made telephone calls to providers because of uncontrolled pain. These rates are consistent with Sumner et al, 68 which suggest a 20% rate of unscheduled health care contact. After perioperative pain management protocol implementation, we had no instances of unscheduled health care contact, which was a significant reduction compared with our historical group ( P = 0.016).…”

Section: Secondary Clinical Outcomessupporting

confidence: 91%

“…Multiple large database reviews report readmission rates of 2% to 9% after DRF treatment. [67][68][69][70] However, these studies do not include other forms of unscheduled health care contact, such as telephone calls. Upon review of our institutional historical cohort, 22% of patients (n = 26 telephone calls, n = 20 urgent care/emergency department presentations, n = 4 both) either presented to the emergency department/ urgent care or made telephone calls to providers because of uncontrolled pain.…”

Section: Secondary Clinical Outcomesmentioning

confidence: 99%

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Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

et al. 2023

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Introduction: Distal radius fractures (DRFs) are common fractures requiring surgical fixation. The literature varies regarding opioid prescribing habits, opioid consumption, and postoperative pain scores. We hypothesized that the preoperative administration of a liposomal bupivacaine (LB) supraclavicular nerve block would be safe and effective in controlling postoperative pain. Methods: A standardized pain management protocol was implemented at a single institution from July 2021 to March 2022 for patients undergoing open reduction internal fixation of DRF. Protocol elements included a preoperative LB supraclavicular nerve block and a multimodal postoperative pain regimen. Primary clinical outcomes included postoperative pain scores and number of opioid tablets consumed. Results: Twenty patients underwent a newly implemented protocol. The average age was 56 years. Mean number of oxycodone 5-mg tablets consumed was 4.1 (median, 2.5), and mean visual analog scale pain score at first postoperative appointment was 2.8. There were no incidences of missed acute carpal tunnel postoperatively. When compared with an institutional historical control (n = 189), number of opioid pills prescribed was reduced by 60% (21.4 vs 8.6 tablets, P < 0.0001), and no patients had unscheduled health care contact because of uncontrolled pain (22% vs 0%, P < 0.016). Conclusions: Liposomal bupivacaine supraclavicular nerve blocks are safe and effective in the treatment of postoperative pain after open reduction internal fixation of DRF. Patients consumed <5 oxycodone tablets on average, which is less than many recommend prescribed quantities (>20-30 tablets). Patients had low pain scores (2.8/10) at the first postoperative follow-up. To our knowledge, this is the first study demonstrating the utility of LB in this clinical setting.

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Section: Secondary Clinical Outcomessupporting

confidence: 91%

Section: Secondary Clinical Outcomesmentioning

confidence: 99%

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

et al. 2023

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“…This is consistent with previous studies that report rates of unplanned readmission after DRF ORIF to be between 0.9% and 8%. 12 , 17 , 24 Based on a multivariable analysis, predictors of readmission after DRF ORIF were identified to be ASA class > 3 (OR = 2.87), functionally dependent status (OR = 2.25), insulin-dependent diabetes (OR = 1.97), and remaining in hospital after the index surgery (inpatient procedure, OR = 2.04).…”

Section: Discussionmentioning

confidence: 99%

Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients

Malpani¹,

John²,

Mercier³

et al. 2020

JAAOS Glob Res Rev

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Purpose: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improvement Program database. Methods: Adult patients who underwent DRF ORIF were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Patient demographics, comorbidity status, hospital metrics, and 30-day perioperative outcomes were tabulated. Readmission, time to readmission, and reason for readmission were assessed. Reasons for readmission were categorized. Risk factors for readmission were assessed with multivariate analyses. Results: Of 11,124 patients who underwent DRF ORIF, 196 (1.76%) were readmitted within 30 days. Based on multivariate analysis, predictors of readmission ( P < 0.05) were as follows: American Society of Anesthesiologist class > 3 (Odds ratio [OR] = 2.87), functionally dependent status (OR = 2.25), diabetes with insulin use (OR = 1.97), and staying in hospital after the index surgery (inpatient procedure, OR = 2.04). Readmissions occurred at approximately 14 days postoperatively. Of the recorded reasons for readmission after DRF ORIF, approximately one quarter were for surgical reasons, whereas over 75% of readmissions were for medical reasons unrelated to the surgery. Conclusion: This study found the rate of 30-day unplanned readmissions after DRF ORIF to be 1.76%. Demographic, comorbid, and perioperative factors predictive of readmission were defined. Most postoperative readmissions were for medical reasons unrelated to the surgical site and occurred at an average of approximately 2 weeks postoperatively. Multivariate analysis found that patients with increased American Society of Anesthesiologist class > 3, functional dependence, insulin-dependent diabetes, and those who underwent inpatient surgery for any reason were at a greater risk for readmission. Understanding these factors may aid in patient counseling and quality improvement initiatives, and this information should be used for risk stratification and risk adjustment of quality measures.

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“…In a retrospective review of 353 patients who sustained DRF at a rural trauma center, Sumner et al found that patients with anxiety or depression were significantly more likely to be readmitted and to pursue unscheduled health care contact, including ED visits, than patients without those comorbidities (39 vs. 16%, p ¼ 0.01); however, they did not assess any type of preoperative intervention. 35 The study by Schwartz et al remains singular in the orthopaedic literature in the evaluation of psychotherapy visits as a preoperative intervention to modify outcomes for depression patients. 34 They found that the psychotherapy cohort had lower rates of health care utilization, including ED visits, 30-day and 90day readmissions, and prolonged lengths of stay, compared with their depression cohort without psychotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, studies have shown that the most common reasons for readmission or ED visits following treatment for DRF are related to pain, and that preoperative diagnoses of DDs are significantly correlated to increased pain intensity following hand surgery. [35][36][37][38][39] At the same time, studies have shown that patients with greater measures of resiliency and self-efficacy, as well as more realistic expectations of outcomes, are more capable of tolerating the pain associated with ORIF for DRF and other upper extremity surgeries. 9,14,40 As such, this is the proposed role of psychotherapy visits, depression screenings, or other nonpharmacologic interventions in targeting and strengthening these facets within patients prior to surgery for DRF, which may in turn lead to a tangible decrease in health care utilization among these patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder

et al. 2023

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Background It is unclear whether nonpharmacologic intervention for depressive disorder (DD) in the preoperative period can prevent postoperative complications in hand surgery patients. Questions/Purpose The aims were to evaluate whether psychotherapy visits/depression screenings within 90 days of open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) were associated with lower rates of (1) medical complications and (2) health care utilization (emergency department [ED] visits and readmissions). Methods A retrospective analysis of an administrative claims database from 2010 to 2021 was performed. DD patients who underwent ORIF for DRF were 1:5 propensity score matched by comorbidities, including those who did (n = 8,993) and did not (n = 44,503) attend a psychotherapy visit/depression screening 90 days before surgery. Multivariate logistic regression models were constructed to compare the odds ratio (OR) of medical complications, ED visits, and readmissions within 90 days. The p-values less than 0.001 were significant. Results DD patients who did not attend a preoperative psychotherapy visit/depression screening experienced fivefold higher odds of total medical complications (25.66 vs. 5.27%; OR: 5.25, p < 0.0001), including surgical site infections (1.23 vs. 0.14%; OR: 8.71, p < 0.0001), deep wound infections (0.98 vs. 0.17%; OR: 6.00, p < 0.0001), and transfusions (1.64 vs. 0.22%; OR: 7.61, p < 0.0001). Those who did not attend a psychotherapy visit/depression screening experienced higher odds of ED utilizations (9.71 vs. 2.71%; OR: 3.87, p < 0.0001), however, no difference in readmissions (3.40 vs. 3.54%; OR: 0.96, p = 0.569). Conclusion Depression screening may be a helpful preoperative intervention to optimize patients with DD undergoing hand surgery to minimize postoperative complications and health care utilization. Level of Evidence Level III.

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Incidence and Reason for Readmission and Unscheduled Health Care Contact After Distal Radius Fracture

Cited by 10 publications

References 23 publications

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

Safety and Efficacy of Liposomal Bupivacaine Supraclavicular Nerve Blocks in Open Treatment of Distal Radius Fractures

Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients

Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder

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