Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index

Kim, Chang-Yeon; Sivasundaram, Lakshmanan; LaBelle, Mark W.; Trivedi, Nikunj N.; Liu, Raymond W.; Gillespie, Robert J.

doi:10.1016/j.jse.2018.03.001

Cited by 58 publications

(46 citation statements)

References 25 publications

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“…12) They reported both measures to be good predictors of postoperative complication, prolonged inpatient stay, discharge to a rehabilitation facility and death. (12) Whilst the Charlson Comorbity Index was higher in patients with prolonged inpatient stay in this study, the Charlson score was not significantly associated with prolonged inpatient stay on multivariate analysis, so our findings do not support this Kim et al's finding. However the Charlson co-morbidity index is made up of individual scores for co-morbidities, some of which were found to be independent predictors of prolonged length of stay, so our data suggest the effect on length of stay appears to arise from the individual co-morbidities rather than the overall Charlson Index.…”

Section: Discussioncontrasting

confidence: 84%

Predictors of length of stay following shoulder arthroplasty in a high-volume UK centre

Dacombe

Harries

McCann

et al. 2020

annals

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Introduction Shoulder arthroplasty rates are increasing in the UK. No data have been published from a UK centre on predictors of length of inpatient stay following shoulder arthroplasty. This study analyses the length of inpatient stay following shoulder arthroplasty in a high-volume UK centre and identifies predictors of prolonged inpatient stay. Materials and methods All shoulder arthroplasty cases performed between 2012 and 2018 were identified. A review of case notes and electronic patient records was completed to identify demographic data, Charlson comorbidity score, length of inpatient stay and factors associated with length of stay. Multiple linear regression analysis was conducted to determine which factors were independently associated with length of inpatient stay. Results A total of 640 shoulder arthroplasty cases were performed in 566 patients. Median length of stay was two days. Length of stay was predicted by age, sex, chronic kidney disease, congestive cardiac failure, previous myocardial infarction, intraoperative complication and postoperative transfusion. Discussion Increasing age, female sex, chronic kidney disease, congestive cardiac failure, previous myocardial infarction, intraoperative complication and transfusion were independent predictors of increased length of stay. Strategies to reduce perioperative complication and transfusion, and to optimise renal and cardiac comorbidities may reduce overall length of stay for shoulder arthroplasty patients.

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Section: Discussioncontrasting

confidence: 84%

Predictors of length of stay following shoulder arthroplasty in a high-volume UK centre

Dacombe

Harries

McCann

et al. 2020

annals

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“…In our study, the CCI and the ECM were not statistically different between the readmitted and non-readmitted patients. Kim et al 18 compared the accuracy of the CCI and ECM for predicting adverse events and postoperative discharge destination after shoulder arthroplasty (TSA and RTSA). They used the National Inpatient Sample between 2002 and 2014 and found that a predictive model using the ECM, in combination with basic demographic variables, outperforms models using the CCI for predicting adverse events and discharge disposition.…”

Section: Discussionmentioning

confidence: 99%

Ninety-day readmissions following reverse total shoulder arthroplasty

et al. 2019

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Background An adequate characterization of 90-day readmissions after primary reverse total shoulder arthroplasty (RTSA) on a national level remains to be undertaken. As bundled payment models become more prevalent, an improved understanding of readmission data will help to predict resource utilization and expenses. Methods All adult patients who underwent elective primary RTSA in 2014 in the National Readmission Database were included in the analysis. Two cohorts were created based on 90-day readmission status. Multivariate analysis was then performed to determine predictors of 90-day readmissions. Reasons for 30-, 60-, and 90-day readmissions were identified. Total hospital resource utilization was calculated. Results An estimated 25,196 patients were identified. The 30-, 60-, and 90-day rates of readmissions were 0.6%, 1.2%, and 1.7%, respectively. Diabetes (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.14-1.78), hypertension (OR, 1.63; 95% CI, 1.28-2.08), paralysis (OR, 3.61; 95% CI, 1.63-7.97), and solid tumor without metastasis (OR, 2.72; 95% CI, 1.21-6.12) were identified as independent predictors of 90-day readmission. Ninety-day readmissions were associated with a significant increase in cost ( P = .02). The most common related reason for 90-day readmission was hardware-related complications at all time points. Conclusion Although uncommon, 90-day readmissions after primary RTSA are associated with significant patient morbidity and consequently substantial hospital costs.

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“…These numbers were selected in order to give equal weight to each comorbidity level for use as a categorical variable. 12 The Cost-to-Charge Ratio Files provided by the HCUP were used to estimate the cost of resources for patients based on the reported total charge. The HCUP used hospital specific cost-to-charge ratios.…”

Section: Methodsmentioning

confidence: 99%

Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

Ragland

Reif

Karim

et al. 2020

Geriatr Orthop Surg Rehabil

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Introduction: Periprosthetic femur fractures (PPFX) are complications of both total hip and knee arthroplasty and may be treated with open reduction and internal fixation (ORIF) or revision arthroplasty. Differences in treatment and fracture location may be related to patient demographics and lead to differences in cost. Our study examined the effects of demographics and treatment of knee and hip PPFXs on length of stay (LOS) and cost. Methods: Of all, 932 patients were identified with hip or knee PPFXs in the National Inpatient Sample from January 2013 to September 2015. Age, gender, race, mortality, comorbidity level, LOS, total cost, procedure type, geographic region, and hospital type were recorded. A generalized linear regression model was conducted to analyze the effect of fracture type on LOS and cost. Results: Differences in gender (66% vs 83.7% female, P < .01), comorbidities (fewer in hips, P < .01), and costs (US$30 979 vs US$27 944, P < .01) were found between the hip and knee groups. Knees had significantly higher rates of ORIF treatment (80.7% vs 39.1%) and lower rates of revision arthroplasties (19.3% vs 60.9%) than hip PPFXs ( P < .01). Within both groups, patients with more comorbidities, revision surgery, and blood transfusions were more likely to have a longer LOS and higher cost. Conclusion: Periprosthetic femur fractures patients are not homogenous and treatment varies between hip and knee locations. For knee patients, those treated with ORIF were younger, with fewer comorbidities than those treated with revision. Conversely, hip patients treated with ORIF were older, with more comorbidities than those treated with revision. Hips had higher costs than knees, and cost correlated with revision arthroplasty and more comorbidities. In both hip and knee groups, longer LOS was associated with more comorbidities and being treated in urban teaching hospitals. Total cost had the strongest associations with revision procedures as well as number of comorbidities and blood product use.

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Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index

Cited by 58 publications

References 25 publications

Predictors of length of stay following shoulder arthroplasty in a high-volume UK centre

Predictors of length of stay following shoulder arthroplasty in a high-volume UK centre

Ninety-day readmissions following reverse total shoulder arthroplasty

Demographics, Treatment, and Cost of Periprosthetic Femur Fractures: Fixation Versus Revision

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