Risk factors for 30-day readmission following hip arthroscopy

Abstract

Purpose Hip arthroscopy is known to be safe with low rates of postoperative complications. The purpose of this study is to evaluate hip arthroscopy cases in a national surgical database to identify risk factors associated with readmission. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2016 for current procedural terminology billing codes related to hip arthroscopy. International Classification of Diseases diagnostic codes were used to exclude cases involving infection, fracture, or open procedures. Univariate and multivariate analyses were performed to identify risk factors associated with 30‐day readmission. Results 1493 patients were identified who had undergone hip arthroscopy. The most common procedures were labral resection or chondroplasty (n = 589, 39.5%) and femoroplasty (n = 527, 35.3%). The 30‐day complication rate was 1.7% and the most common complications following the procedure were bleeding (n = 12, 0.8%) superficial infections (n = 5, 0.3%), and returning to the operating room (n = 4, 0.3%). The 30‐day readmission rate was 1.3%. On multivariate analysis, hypertension requiring anti‐hypertensive medication (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4–8.7) and chronic corticosteroid or immunosuppressant use (OR 7.2; 95% CI 1.9–26.7) were identified as independent risk factors for readmission. There was no difference in complication rates when hip arthroscopy was performed with isolated femoroplasty (n = 340), isolated acetabuloplasty (n = 103), both (n = 187) or neither (n = 863). Conclusion These findings confirm that the 30‐day readmission (1.3%) and complication rate (1.7%) are low for isolated hip arthroscopy procedures; however, hypertension and chronic steroid use are independent risk factors for readmission. Level of evidence Retrospective comparative study, Level III.

Editorial Commentary: Readmission Rate After Hip Arthroscopy: Is There a Cause for Concern?

“…They did not report on the readmission rate. Hartwell et al 7 seem to have covered a similar period as the current study from 2012 to 2016 in their publication earlier this year and reported a slightly greater readmission rate of 1.3% in a group of 1493 patients. They identified bleeding (n ¼ 12, 0.8%), superficial infection (n ¼ 5, 0.3%), and return to operating room (n ¼ 4, 0.3%) as the most common events.…”

“…There are a couple of limitations of the study that need to be highlighted, one being its similarity to the work by Hartwell et al 7 using the same database; unsurprisingly, the conclusions are not very different. It must be admitted that the focus of the study by Hartwell et al 7 was the 30-day complication rate and they attempted to determine its association with several surgical factors; in contrast, the current study has explored the medical associations at length and the authors should be congratulated for their attempt. It can also be critiqued that for a study including data from 693 participating hospitals, one would expect a larger cohort of patients, which is perhaps even more valuable if the incidence of the complications is very small.…”

“…For a predominantly young population, even this figure appears to be high but contrasts favorably with the overall readmission rate of 5.4% after orthopaedic surgery. 5 The NSQIP database has been explored previously by Cvetanovich et al 6 and very recently by Hartwell et al 7 to examine 30-day postoperative complications following hip arthroscopy. Cvetanovich et al 6 looked at a cohort of 1338 hip arthroscopic procedures recorded in the database from 2006 to 2013 and reported a return to theater of 0.3%, superficial infection rate of 0.2%, deep venous thrombosis 0.1%, and death 0.1%.…”

Risk of Infection in Knee Arthroscopy Patients Undergoing Corticosteroid Injections in the Perioperative Period

“… 2 , 3 , 13 , 20 , 27 Chronic systemic steroid use has also been associated with significantly increased complication rates after arthroscopy. 9 , 31 Westermann et al 31 noted a 3-fold increased rate of readmission because of surgical-site infection and wound complications in patients with chronic steroid use who had knee and shoulder arthroscopy.…”

Editorial Commentary: Emergency Department Evaluation After Hip Arthroscopy Occurs More than Expected: Here’s Where Patient Education and a Multimodal Approach to Pain Management Can Be Helpful

“…Prior studies have identified low 30-day readmission rates (0.5%-1.3%) following hip arthroscopy; however, as this study suggests, this may underestimate the rate at which these patients seek outpatient medical attention. 2,5 They identified a 30-day postoperative emergency department evaluation rate of 3.5% along with a 0.13% 30-day readmission rate. The current study provides unique and valuable information regarding the postoperative complications that lead patients to seek medical care after hip arthroscopy.…”