Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

Miletic, Kyle; Taylor, Thomas N.; Martin, Emily T.; Vaidya, Rahul; Kaye, Keith S.

doi:10.1086/674854

Cited by 27 publications

(20 citation statements)

References 22 publications

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“…It has been used previously to study readmission in adults with a number of different conditions. 27,28 However, this is the first study of pediatric critical illness with both a large and diverse patient population, supplemented by rich longitudinal health care utilization data over long periods of time.…”

Section: Discussionmentioning

confidence: 99%

Readmission and Late Mortality After Critical Illness in Childhood*

Hartman

Saeed

Bennett

et al. 2017

Pediatric Critical Care Medicine

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Objectives Little is known about the ongoing mortality risk and healthcare utilization among U.S. children after discharge from a hospitalization involving ICU care. We sought to understand risks for hospital readmission and trends in mortality during the year following ICU discharge. Design We performed a retrospective observational cohort study using administrative claims data from the years 2006–2013 obtained from the Truven Health Analytics MarketScan® Database. Subjects We included all children in the dataset admitted to a U.S. ICU ≤18 years old. Interventions The primary outcome was non-elective readmission in the year following discharge. Risk of rehospitalization was determined using a Cox proportional hazards model. Measurements and Main Results We identified 109,130 children with at least one ICU admission in the dataset. Over three-quarters of the index ICU admissions (78.6%) had an ICU length of stay ≤ 3 days and the overall index hospitalization mortality rate was 1.4%. In multivariate analysis, risk of non-elective readmission for children without cancer was higher with longer index ICU admission LOS, younger age, and several chronic and acute conditions. By the end of the one year observation period, 36.0% of children with an index ICU LOS ≥ 14 days had been readmitted, compared to only 13.9% of children who had an index ICU LOS = 1 day. Mortality in the year after ICU discharge was low overall (106 deaths per 10,000 person-years of observation), but was highest among children with an initial index ICU admission LOS ≥ 14 days (599 deaths per 10,000 person-years). Conclusions Readmission after ICU care is common. Further research is needed to investigate the potentially modifiable factors affecting likelihood of readmissions after discharge from the ICU. While late mortality was relatively uncommon overall, it was ten-fold higher in the year after ICU discharge than in the general U.S. pediatric population.

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Section: Discussionmentioning

confidence: 99%

Readmission and Late Mortality After Critical Illness in Childhood*

Hartman

Saeed

Bennett

et al. 2017

Pediatric Critical Care Medicine

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“…However, these treatments fail to effectively alleviate symptoms for many patients [2]. Many pharmaceutical companies have also recently closed research programs for OA due to the complexity of treatments and the difficulty in demonstrating their efficacy in clinical trials [29]. Thus, there exists a need for the development of new, more effective therapies to treat knee OA.…”

Section: Discussionmentioning

confidence: 99%

Knee Osteoarthritis Treated with Percutaneous Chondral-Bone Interface Optimization: A Pilot Trial

Vad¹,

Barve²,

Linnell³

et al. 2016

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Objective: The objective is to evaluate the efficacy of using tibial bone marrow delivered to the chondral-bone interface (CBI) via percutaneous chondral bone interface optimization (PeCaBoo) as a therapy for knee osteoarthritis (OA). Study Design: A series of prospective cases were presented. Participants: Our study included 10 patients with medial or lateral compartment knee OA. Methods: With 1 cc of heparin pre-loaded in the syringe, 5 cc of tibial bone marrow was withdrawn from the proximal tibia. The resultant 6 cc of aspirate in the syringe was injected via PeCaBoo, 2 cc at a time, into the superior CBI and inferior CBI. The remaining 2 cc was injected via needle into the intra-articular joint space. Main Outcome Measurements: Patients had MRIs taken pre-procedure and 3 months post-procedure to measure bone edema and intra-articular matrix thickness. Patient-reported outcomes recorded included the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Numeric Paint Rating Scale (NRS), which were both obtained pre-procedure and post-procedure at 3, 6, and 12 months. Use of non-steroidal anti-inflammatories (NSAIDs) was recorded pre-and post-procedure as well. Results: Our study included 4 males and 6 females, with an average age of 63.5 years. The average follow-up time was 14 months, with a range of 13 -15 months. The mean WOMAC score was 58.2 points pre-procedure and 35.3 points post-procedure (p < 0.01). The mean NRS-Pain score was 8.6 points pre-procedure and 2.8 points post-procedure (p < 0.01). The matrix thickness increased by 14% on average at 3 months postprocedure (p < 0.01). The proportion of patients taking NSAIDs decreased by 60% after the PeCaBoo procedure. The subgroup of patients with tibial edema and knee OA had optimal outcomes. Conclusions: Tibial bone marrow stem cell delivered via PeCaBoo is a novel minimally-invasive treatment for knee OA, with potential to repair cartilage and improve knee pain and function. * Corresponding author. V. Vad et al.2

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“…This could also contribute to reduced hospital costs, which are high when patients are readmitted with postoperative infections. 34 35 36 In one Swedish study, the cost of readmission for small bowel obstruction was approximately equal to that of gastric cancer treatment. 37 Another potential benefit is the limitation of abdominal CT scanning to only those patients with a high probability of abscess, which would further contribute to the reduction of hospital costs.…”

Section: Discussionmentioning

confidence: 99%

Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer

et al. 2015

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PurposeIntraabdominal abscess is one of the most common reasons for re-hospitalization after gastrectomy. This study aimed to develop a model for estimating the probability of intraabdominal abscesses that can be used during the postoperative period.Materials and MethodsWe retrospectively reviewed the clinicopathological data of 1,564 patients who underwent gastrectomy for gastric cancer between 2010 and 2012. Twenty-six related markers were analyzed, and multivariate logistic regression analysis was used to develop the probability estimation model for intraabdominal abscess. Internal validation using a bootstrap approach was employed to correct for bias, and the model was then validated using an independent dataset comprising of patients who underwent gastrectomy between January 2008 and March 2010. Discrimination and calibration abilities were checked in both datasets.ResultsThe incidence of intraabdominal abscess in the development set was 7.80% (122/1,564). The surgical approach, operating time, pathologic N classification, body temperature, white blood cell count, C-reactive protein level, glucose level, and change in the hemoglobin level were significant predictors of intraabdominal abscess in the multivariate analysis. The probability estimation model that was developed on the basis of these results showed good discrimination and calibration abilities (concordance index=0.828, Hosmer-Lemeshow chi-statistic P=0.274). Finally, we combined both datasets to produce a nomogram that estimates the probability of intraabdominal abscess.ConclusionsThis nomogram can be useful for identifying patients at a high risk of intraabdominal abscess. Patients at a high risk may benefit from further evaluation or treatment before discharge.

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Readmissions after Diagnosis of Surgical Site Infection Following Knee and Hip Arthroplasty

Abstract: Readmissions during the year after SSI diagnosis accounted for 1,072 hospital admissions and cost over $25.5 million. These readmissions are costly and might be a future target for decreased reimbursement.

Cited by 27 publications

References 22 publications

Readmission and Late Mortality After Critical Illness in Childhood*

Readmission and Late Mortality After Critical Illness in Childhood*

Knee Osteoarthritis Treated with Percutaneous Chondral-Bone Interface Optimization: A Pilot Trial

Nomogram Estimating the Probability of Intraabdominal Abscesses after Gastrectomy in Patients with Gastric Cancer

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