Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital

Varacallo, Matthew; Herzog, Leah; Toossi, Nader; Johanson, Norman A.

doi:10.1016/j.arth.2016.12.035

Cited by 55 publications

(35 citation statements)

References 38 publications

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“…1,2,5,31,32 The American College of Surgeons National Surgical Quality Improvement Program began tracking readmissions in 2011. 33 Medicare had also placed an emphasis on readmission reduction well before the HRRP policy through the Hospital Compare program which privately reported readmission data for select medical conditions to hospitals in 2009 and began publically reporting this information in 2010.…”

Section: Discussionmentioning

confidence: 99%

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

et al. 2018

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Importance Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective To evaluate the effect of this policy on readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (non-targeted). Design Using a 20% Medicare sample we performed a retrospective cohort study of patients undergoing one of five major surgeries between January 1, 2006 and November 30, 2014. Setting Population based analysis. Participants Our study included 507,663 patients with targeted (total hip arthroplasty, total knee arthroplasty) and 164,472 patients with non-targeted (abdominal aortic aneurysm repair, colectomy, lung resection) procedures performed at 2,773 hospitals. Exposure Implementation of the HRRP policy. Main Outcomes and Measures We calculated hospital level 30-day risk-adjusted rates of readmission and observation stays using multivariable logistic regression models. Changes in these rates were analyzed for three distinct time periods (Pre-policy (1/1/2006 to 6/30/2010), Performance (7/1/2010 to 6/30/2013), Penalty (7/1/13 to 11/30/14)) corresponding to the HRRP implementation timeline for major joint surgery, using interrupted time series. Results Readmissions for all procedures decreased significantly over the study period. Readmission rates after targeted procedures decreased faster during the Performance period (slope: −0.060, 95% CI: −0.079 to −0.041) compared to the Pre-policy period (slope: −0.012, 95% CI: −0.027 to 0.034, p <0.002). For non-targeted procedures, readmission rates were decreasing during the Pre-policy period (slope: −0.20, 95% CI: −0.24 to −0.16) but stabilized during the Performance period (slope: 0.0084, 95% CI: −0.049 to 0.066, p <0.001). Use of observation stays increased slightly, accounting for 11% of the decrease in readmissions. Conclusions The HRRP effectively decreased readmissions for targeted procedures. There were no associated spillover effects for common non-targeted procedures. A better understanding of differences in impact of the policy across medical and surgical discharges will be necessary to further enhance its effects and generalizability.

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Section: Discussionmentioning

confidence: 99%

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

et al. 2018

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“…These include surgeon volume, operative time, general anesthesia, use of anticoagulation other than aspirin, increased length of hospital stay, and discharge to an inpatient rehabilitation facility [43][44][45][46][47]. Kurtz et al [44] found that increased surgeon volume has a protective effect against readmissions after TJA.…”

Section: Perioperative Risks For Readmissionmentioning

confidence: 99%

“…2 The graph shows our TKA data for length of stay <2 days, readmission percentage, discharge to skilled nursing facilities, and average length of stay experience and volume plays a role in decreasing operative time. Varacallo et al [45] found that use of general anesthesia is an independent risk factor for 30-day readmission after TJA. This supports the practice of using spinal anesthesia.…”

Section: Perioperative Risks For Readmissionmentioning

confidence: 99%

“…This may be partially due to the fact that increased hospital length of stay can increase the risk of hospital-acquired infections and thromboembolic events. Lastly, multiple studies have shown that discharge to inpatient facilities is associated with worse outcomes and increased rates of readmission [43][44][45][46][47]. A study by Fu et al [47] showed that discharge to inpatient facilities is independently associated with a higher rate of readmission and increased risk for a number of postdischarge complications.…”

Section: Perioperative Risks For Readmissionmentioning

confidence: 99%

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Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

Sveom¹,

Otteman²,

Garvin³

2017

Curr Rev Musculoskelet Med

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Purpose of review Total joint arthroplasty (TJA) has had an increased demand over the recent years. It is a successful procedure, and there are relatively few complications, but there is a high overall cost. There is a push to increase the quality of care, lessen complications, and decrease cost by reducing readmissions. This article will discuss the risk factors that can contribute to the complication and readmission rates following TJA. Recent findings Several risk factors have been found to contribute to the complication and readmission rates following a TJA. It is important to understand these risk factors and mitigate them as much as possible in order to optimize the patient experience. There are risk factors that cannot be modified, and the treatment team as well as the patient should be made aware of these and account for them when making the decision whether to undergo elective primary TJA or not. In general, an increased number of risk factors is associated with increased complications and increased readmission rates. At our institution, we have used this knowledge to improve our outcomes and decrease costs. Summary It is important to be mindful of risk factors for poor outcomes prior to performing TJA. This allows for the optimization of patients prior to undergoing surgery. This can lead to improved outcomes at a lower cost.

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“…Uncemented total hip arthroplasty (THA) is one of the most cost-effective and consistently successful surgeries performed in orthopedics. THA provides reliable outcomes for patients' suffering from endstage degenerative hip osteoarthritis, speci cally pain relief, functional restoration, and overall improved quality of life [1]. THA patients must undergo initial stabilization to obtain long-term durability.…”

Section: Introductionmentioning

confidence: 99%

The Local Concentration of Ca2+ Correlates with BMP7 Expression and Osseointegration in Patients with Total Hip Arthroplasty

Wang

et al. 2020

Preprint

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Background A successful osseointegration of total hip arthroplasty (THA) relies on the interplay of implant surface and bone marrow microenvironment. This study was undertaken to investigate the impact of perioperative biochemical molecules (Ca 2+ , Mg 2+ , Zn 2+ , VD, PTH) on the bone marrow osteogenetic factors (BMP2, BMP7, Stro-1 + cells) in the metaphyseal region of the femoral head, and further on the bone mineral density (BMD) of Gruen R3. Methods Bone marrow aspirates were obtained from the discarded metaphysis region of the femoral head in 51 patients with THA. Flow cytometry was used to measure the Stro-1 + expressing cells. ELISA was used to measure the concentrations of bone morphologic proteins (BMP2 and BMP7). The perioperative concentrations of the biochemical molecules above were measured by radioimmunoassay. The BMD of Gruen zone R3 was examined at 6 months after THA, using dual-energy X-ray absorptiometry (DEXA). Results Our data demonstrated that the concentration of Ca 2+ was positively correlated with BMP7 expression, and with the postoperative BMD of Gruen zone R3. However, the concentration of Mg 2+ had little impact on the R3 BMD, although it was negatively correlated with the expression of BMP7. The data also suggested that the other biochemical molecules, such as Zn 2+ , VD, and PTH, were not significantly correlated with any bone marrow osteogenetic factors (BMP2, BMP7, Stro-1 + cells). The postoperative R3 BMD of patients of different gender and age had no significant difference. Conclusions These results indicate the local concentration of Ca 2+ may be an indicator for the prognosis of THA patients.

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Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital

Cited by 55 publications

References 38 publications

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

Improving Quality and Decreasing Cost by Reducing Re-admissions in Patients Undergoing Total Joint Arthroplasty

The Local Concentration of Ca2+ Correlates with BMP7 Expression and Osseointegration in Patients with Total Hip Arthroplasty

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