Patient Risk Factors Do Not Impact 90-Day Readmission and Emergency Department Visitation After Total Ankle Arthroplasty

Cunningham, D. J.; Karas, Vasili; DeOrio, James K.; Nunley, James A.; Easley, Mark E.; Adams, Samuel B.

doi:10.2106/jbjs.17.01149

Cited by 22 publications

(18 citation statements)

References 16 publications

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“…Previous literature described that with TAA, higher comorbidity was not associated with readmission 20 , failure 14 , or revision 21 . However, the adverse impact of comorbidities on TAA complication has been previously documented by several authors 22 , 23 .…”

Section: Discussionmentioning

confidence: 76%

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Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Lee

Song

et al. 2021

Sci Rep

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The failure rate of TAA is still higher than that of other joint replacement procedures. This study aimed to calculate the early failure rate and identify associated patient factors. Data from the Korean Health Insurance Review and Assessment Service database from 2009 to 2017 were collected. We evaluated patients who had TAA as a primary surgical procedure. Early failure was defined as conversion to revision TAA or arthrodesis after primary TAA within five years. Patients with early failure after primary TAA were designated as the “Failure group”. Patients without early failure and who were followed up unremarkably for at least five years after primary TAA were designated as the “No failure group”. Overall, 2157 TAA participants were included. During the study period, 197 patients developed failure within five years postoperatively, for an overall failure rate of 9.1%. Significant risk factors for early failure were history of chronic pulmonary disease, diabetes, peripheral vascular disease, hyperlipidemia, dementia, and alcohol abuse. A significant increase of odds ratio was found in patients with a history of dementia, chronic pulmonary disease, and diabetes. Surgical indications and preoperative patient counseling should consider these factors.

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Section: Discussionmentioning

confidence: 76%

“…Previous studies measured comorbidity with Deyo-Charlson index, without differentiating each comorbidity 7 , 14 , 21 . In addition, there are few large series in which all the comorbidities have been assessed concomitantly 20 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Lee

Song

et al. 2021

Sci Rep

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“… 24 , 25 , 26 In invasive thoracic surgeries, 30-day ED visit rates following thoracotomy for pleuropulmonary disease, coronary artery bypass grafting, and esophagectomy were 6%, 27 12%, 28 and 16%, 29 respectively. Concerning orthopedic procedures, ED visit rates in the 1-month period following total hip or knee replacement surgery and the 90-day period following total ankle arthroplasty were 6% 30 and 3.5%, 31 respectively. In spine surgery specifically, Pak et al 32 reported a 30-day postoperative ED visit rate of 15% after common procedures such as lumbar arthrodesis, diskectomy, and decompression with the primary complaint being low back pain.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

et al. 2020

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Background Postoperative emergency department (ED) visits following suboccipital decompression in Chiari malformation type I (CM-1) patients are not well described. We sought to evaluate the magnitude, etiology, and significance of postoperative ED service utilization in adult CM-1 patients at a tertiary referral center. Methods A prospectively maintained database of CM-1 patients seen at our institution between January 1, 2006 and December 31, 2019 was used. ED visits occurring within 30 days after surgery were tracked for postoperative patients, while comparing clinical, imaging, and operative characteristics between patients with and without an ED visit. Clinical improvement at last follow-up was also compared between both groups of patients in a univariable and multivariable analysis using the Chicago Chiari Outcome Scale (CCOS). Results In 175 surgically treated patients, 44 (25%) visited an ED in the 1-month period after surgery. The most common reason for seeking care was isolated headache (41%), and concentration disturbance at presentation was the only factor significantly associated with a postoperative ED visit ( P = 0.023). The occurrence of a postoperative ED visit was independently associated with a lower chance of clinical improvement at last follow-up (adjusted odds ratio of CCOS ≥13 = 0.35, P = 0.021; adjusted odds ratio of CCOS ≥14 = 0.38, P = 0.016). Conclusions Adult CM-1 patients undergoing surgery at a tertiary referral center have an elevated rate of postoperative ED visits, which are mostly due to pain-related complaints. Such visits are hard to predict but are associated with worse long-term clinical outcome. Interventions that decrease the magnitude of postoperative ED service utilization are warranted.

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“…7,12,19,21 Within the TAA literature, however, relatively few studies have examined length of stay, post–acute care, or readmissions in a bundled payment context, and none have examined how often costs exceed the bundled payment target. 1,4-6…”

mentioning

confidence: 99%

“…7,12,19,21 Within the TAA literature, however, relatively few studies have examined length of stay, post-acute care, or readmissions in a bundled payment context, and none have examined how often costs exceed the bundled payment target. 1,[4][5][6] The purpose of this study was to (1) determine the rate at which TAA costs exceed the CJR target payments (primary outcome), (2) investigate patient demographics and comorbidities associated with exceeding CJR targets, and (3) compare these results with a similar institutional cohort of total hip and knee arthroplasty cases performed during the same period.…”

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confidence: 99%

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

et al. 2019

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Background: The Comprehensive Care for Joint Replacement (CJR) model includes total ankle arthroplasty (TAA), under which a target reimbursement is established. Whether this reimbursement is sufficient to cover average cost remains unknown. We hypothesized that a substantial number of TAAs still exceed cost targets, and that risk factors associated with exceeding the target cost could be identified preoperatively. Methods: Two hundred two primary TAAs performed at a single tertiary referral center under the CJR model from June 2013 to May 2017 were retrospectively reviewed. Patient demographics, comorbidities, outcomes, and costs were extracted from the electronic medical record using a validated structured query language (SQL) algorithm. A comparison cohort of 2084 CJR total hip arthroplasty (THA) and total knee arthroplasty (TKA) cases performed during the same period was also reviewed. Results: Twenty TAAs (10%) exceeded the target cost of care, significantly fewer than CJR THAs/TKAs (29%) performed during the same period ( P < .0001). These patients did not differ significantly in age, sex, body mass index, number of Elixhauser comorbidities, or the American Society of Anesthesiologists score. The average cost for these patients was $17 338 higher than those who did not exceed the target cost, and they were less likely to be married or have a partner (45% vs 79%, P = .001). Non-Caucasian status also reached significance ( P < .0001). Those exceeding the target cost had a significantly longer length of stay (2.6 vs 1.5 days, P < .0001) and were more likely to be discharged to either skilled nursing or a rehabilitation facility (60% vs 1%, P < .0001). Conclusion: Even high-volume TAA centers still exceed target costs in up to 10% of cases, with length of stay, discharge location, and readmissions driving many of these events. Potential risk factors for excess cost include marital/partner status and non-Caucasian ethnicity, but further work is needed to clarify their effects and whether other risk factors exist. Level of Evidence: Level III, comparative study.

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Patient Risk Factors Do Not Impact 90-Day Readmission and Emergency Department Visitation After Total Ankle Arthroplasty

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 22 publications

References 16 publications

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Analysis of early failure rate and its risk factor with 2157 total ankle replacements

Emergency Department Visits Following Suboccipital Decompression for Adult Chiari Malformation Type I

Patients at Risk for Exceeding CJR Cost Targets After Total Ankle Arthroplasty

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