Risk factors for hospital admission in patients undergoing outpatient anterior cruciate ligament reconstruction: A national database study

Min, Cris J.; Partan, Matthew J.; Koutsogiannis, Petros; Iturriaga, Cesar; Katsigiorgis, Gus; Cohn, Randy M.

doi:10.1016/j.jor.2020.09.020

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…However, our results could demonstrate the significant effect of surgical invasiveness in patients undergoing AKAS and potentially reveal the statistically significant independent predictor of UOA by multivariate analysis (Tables 3 and 4 ). Second, the incidence of UOA and the findings in this study might be affected by the study inclusion criteria (as ASA status grades 1–2 and the absence of a bleeding disorder) and some uncommon potential factors for UOA (e.g., chronic disease, morbid obesity, and smoking status [ 10 , 11 , 18 ]). Lastly, our results may not be directly applicable in the other conditions related to the use of tourniquet, such as arthroscopic knee surgery without tourniquet inflation [ 13 ] and the setting of tourniquet pressure based on limb occlusion pressure (this study used only a 350-mmHg tourniquet pressure setting protocol) [ 12 ].…”

Section: Discussionmentioning

confidence: 97%

“…Nevertheless, previous studies showed that some patients who underwent AKAS still do not experience the expected post-operative recovery and require overnight stay with an incidence of the unplanned overnight admission (UOA) ranged from 0.0004 to 20% [ 4 – 6 ], and the most common cause for UOA was severe post-operative pain [ 6 ], while previous studies mostly focused on the factors associated with readmission after AKAS especially in an anterior cruciate ligament (ACL) reconstruction [ 7 – 9 ]. To the best of our knowledge, only few studies explored the factors related to UOA and how to predict UOA after AKAS [ 10 , 11 ]. Moreover, there were some variations on the peri-operative protocol that might affect the UOA too such as the anaesthetic technique [ 5 ], the use of tourniquet and setting pressure [ 12 , 13 ], and the standardization of operative procedures [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients

Saengpetch

Watcharopas

Kujkunasathian

et al. 2022

International Orthopaedics (SICOT)

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Purpose Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized peri-operative protocol for the AKAS and identify whether a correlation exists between the peri-operative surgical factors and UOA in the patients undergoing AKAS. We hypothesized that more surgical invasiveness and prolong tourniquet time increase the risk of UOA after AKAS. Method A prospective cohort study was conducted between October 2017 and March 2021. All 184 patients operated on standard AKAS protocol. The UOA is defined as overnight hospitalization of a patient undergoing AKAS. Demographic and peri-operative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (intra-articular soft tissue surgery) (n = 65) and more complex surgery (involving extra-articular soft tissue surgery or ligamentous reconstruction) (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate analysis. Results The incidence of UOA in the more complex group (n = 7, 14.3%) was significantly higher than in the less invasive group (n = 3, 4.6%) (p = 0.049). The peri-operative factors significantly associated with UOA were age, more complex surgery, and longer tourniquet time (p < 0.10 all). However, the multivariate analysis revealed that longer tourniquet time was the only significant predictor for UOA (OR = 1.045, 95% CI = 1.022–1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. Conclusion The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. This study showed that unplanned admission significantly associated with many factors—as patient factors, surgical invasiveness, and tourniquet time. However, tourniquet time is the only independent predictor for UOA. Therefore, strict perioperative management protocol must be applied in AKAS, and all patients having these risk factors should be prepared for UOA.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients

Saengpetch

Watcharopas

Kujkunasathian

et al. 2022

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…Second, the incidence of UOA and the findings in this study might be affected by the study criteria. Due to the inclusion criteria of ASA status grade 1 and 2 and the absence of a bleeding disorder, some potential factors for UOA (e.g., chronic disease, morbid obesity, and smoking status 10,11,20 ) would be significantly lower or not found in our study population. Lastly, although this study showed that tourniquet time significantly predicted the UOA, our results may not be directly applicable in the other conditions related to the use of tourniquet, such as arthroscopic knee surgery without tourniquet inflation 13 and the setting of tourniquet pressure based on limb occlusion pressure (this study used only a 350-mmHg tourniquet pressure setting protocol) 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that unplanned overnight admission (UOA) ranged from 0.0004% to 20% 4,5,6 , and the most common cause for UOA was severe postoperative pain 6 . While previous studies mostly focused on the factors associated with readmission after AKAS, especially on anterior cruciate ligament (ACL) reconstruction 7,8,9 , to the best of our knowledge, only a few studies explored the factors related to UOA and how to predict UOA after AKAS 10,11 . Moreover, there were some variations on the perioperative protocol that might affect the UOA after AKAS, such as the anesthetic technique 5 , the use of tourniquet and setting pressure 12,13 , and the standardization of operative procedures 4 .…”

Section: Introductionmentioning

confidence: 99%

Predicting Surgical Factors for Unplanned Overnight Admission in Ambulatory Arthroscopic Surgery of the Knee: A Prospective Cohort in 184 patients

Watcharopas

Saengpetch

Kijkunasathian

et al. 2021

Preprint

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Background: Unplanned overnight admission (UOA) is an important indicator for quality of care with ambulatory knee arthroscopic surgery (AKAS). However, few studies have explored the factors related to the UOA and how to predict UOA after AKAS. This study aimed to evaluate the effectiveness of a standardized perioperative protocol for the AKAS with UOA and identify whether a correlation exists between the perioperative surgical factors and UOA in the patients undergoing AKAS. Methods: A prospective cohort study was conducted, between October 2017 and March 2021, in 184 patients. All patients operated on standard AKAS protocol. The UOA was defined as overnight hospitalization of a patient undergoing AKAS. Demographic and perioperative data were recorded, and the procedure was categorized based on the surgical invasiveness based on less invasive (n = 65) and more complex surgery (n = 119). The clinical risk factors for UOA were identified and analyzed with multivariate logistic regression analysis. Results: The incidence of UOA in the more complex group (17 cases, 14.3%) was significantly higher than in the less invasive group (3 cases, 4.6%) (p = 0.049), with the incidence of readmission as 0%. The perioperative factors significantly associated with UOA were age, more complex surgery, and tourniquet time (p < 0.10 all). However, the multivariate regression analysis revealed that tourniquet time was the only significant predictor for UOA (odds ratio = 1.045, 95% confidence interval = 1.022 to 1.067, p = 0.0001). The optimal cut-off points of tourniquet time for predicting UOA with the highest Youden index in the less invasive and more complex groups were 56 minutes and 107 minutes, respectively. Conclusion: The UOA after AKAS is more common in more complex surgery compared to less invasive surgery. Many factors—such as patient factors, surgical invasiveness, and tourniquet time—were also significantly associated with the unplanned admission. However, the results from this study showed that, under strict perioperative management protocol, tourniquet time is the only independent predictor for UOA.

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“…Grundlegend ist eine arthroskopische Behandlung von Kreuzbandrupturen und Meniskusnähten bzw. -resektionen ambulant in gleicher Qualität möglich [ 16 , 18 , 19 , 22 ].…”

Section: Diskussionunclassified

Ambulantisierungspotenzial stationärer Fälle einer universitären Klinik für Orthopädie und Unfallchirurgie

Henkelmann

Dercks

2021

Unfallchirurgie

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Zusammenfassung Hintergrund Durch das Reformgesetz des Medizinischen Dienstes der Kassen (MDK) soll u. a. eine Verlagerung bislang stationär erbrachter Leistungen in den ambulanten Versorgungsektor bzw. die Versorgung nach §115b SGB V umgesetzt werden. Ziel dieser Arbeit ist die Untersuchung bestimmter Gruppen stationärer Fälle eines universitären Maximalversorgers für Unfallchirurgie und Orthopädie, die das Risiko einer operativen Ambulantisierung tragen. Methodik Die Datenerfassung mittels SAP Data Warehouse umfasst alle stationären Fälle 2017–2019. Es erfolgt die Subgruppenanalyse der Krankenhausleistungsparameter von 3 potenziellen Risikogruppen (RG): 1) primäre Fehlbelegungen, 2) Katalogleistungen der AOP-Kategorie 1 und/oder 2 sowie 3) elektive Eintagesfälle als hypothetische Risikogruppe. Zudem erfolgt eine Analyse epidemiologischer und ökonomischer Parameter. Ergebnisse Eine primäre Fehlbelegung (RG 1) wurde vom MDK in 245 Fällen beanstandet. RG 2 umfasst 764 Fälle und RG 3 891 Fälle. Das Kollektiv wies ein Durchschnittsalter von 45,5 ± 17,7 Jahren auf und zeigte in 90 % keine relevanten Nebendiagnosen (PCCL 0). Der Hauptanteil der Fälle ließ sich den DRG I23B und I21Z (Entfernung von Osteosynthesematerial, 15–23 %) zuordnen, nachfolgend offenen oder arthroskopischen Eingriffen an den Extremitäten (DRG I32F, I32G, I24Z, I18B, 6–9 %). Im Falle einer zunehmenden Ambulantisierung ergibt sich ein potenzielles Erlösrisiko 2017 von 1.049.207 €, 2018 von 1.076.727 € und 2019 von 923.163 €. Schlussfolgerung Einzelne Gruppen haben ein erhöhtes Transferpotenzial in bestimmten DRG für ambulante Operationen. Eine proaktive Patientensteuerung in Bezug auf ambulante vs. stationäre Behandlung sowie ein besonderes Management personeller und räumlicher Ressourcen sind notwendig, um nachgelagerte Erlöskürzungen zu antizipieren.

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Risk factors for hospital admission in patients undergoing outpatient anterior cruciate ligament reconstruction: A national database study

Cited by 8 publications

References 25 publications

Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients

Predicting surgical factors for unplanned overnight admission in ambulatory arthroscopic surgery of the knee: a prospective cohort in one hundred and eighty four patients

Predicting Surgical Factors for Unplanned Overnight Admission in Ambulatory Arthroscopic Surgery of the Knee: A Prospective Cohort in 184 patients

Ambulantisierungspotenzial stationärer Fälle einer universitären Klinik für Orthopädie und Unfallchirurgie

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