Thirty-Day Readmission Rates as a Measure of Quality: Causes of Readmission After Orthopedic Surgeries and Accuracy of Administrative Data

McCormack, Richard; Michels, Ryan; Ramos, Nicholas; Hutzler, Lorraine; Slover, James; Bosco, Joseph

doi:10.1097/00115514-201301000-00011

Cited by 44 publications

(39 citation statements)

References 10 publications

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“…This is not a safe practice. The shortcomings of using coding to determine quality metrics have been reported previously [1,14,19,24]. We found that the CMS definition of planned, which is currently used for withholding reimbursements from hospitals, labeled 30 readmissions that our authors felt were safe, best-practice management (as defined by the clinical definition) as unplanned readmissions.…”

Section: Discussionmentioning

confidence: 67%

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Bernatz

Tueting

Hetzel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The Centers for Medicare & Medicaid Services (CMS) now include hip and knee replacements in the Hospital Readmission Reduction Program. The 30-day readmission rate is an important quality metric; however, the incidence has not yet been defined across the numerous orthopaedic subspecialties. Elucidating the readmission rate for each subspecialty may indicate that certain services are being disincentivized by the CMS reimbursement program.

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Section: Discussionmentioning

confidence: 67%

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Bernatz

Tueting

Hetzel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…McCormack, et al, 2013 (22) J Healthc Manag Identifying causes of planned and unplanned readmission within 30 days.…”

Section: Resultsmentioning

confidence: 99%

“…In analyzing the variable of interest of this review, meaning the readmission characteristics from orthopedic surgical site infection, it was found that the objectives of included publications varied between characterizing unplanned readmissions within 30 days after discharge (20)(21)(22)(23) , identifying predictors of surgical readmission within 30 days in overall readmission rates (24) , assessing their impact on costs, average stay and overall readmission rates, as well as its causes and risk factors (20)(21)(25)(26) and associated comorbidities (27) . Studies analyzing the impact of seasonality (28) and influence of goals and educational video programs on events that also included readmission (29) were also performed.…”

Section: Discussionmentioning

confidence: 99%

“…In the global context of readmissions, there was a predominance in readmissions related to surgical services observed when compared to clinical (21)(22) . This fact is confirmed by a study that analyzed the unplanned readmissions and compared their causes between medical and surgical discharges, where it found that postoperative complications accounted for 70.5% of readmissions related to surgical discharges (3) .…”

Section: Discussionmentioning

confidence: 99%

“…This fact is confirmed by a study that analyzed the unplanned readmissions and compared their causes between medical and surgical discharges, where it found that postoperative complications accounted for 70.5% of readmissions related to surgical discharges (3) . Surgical site infection was also the most common type of infection, with a predominance of those classified as deep (4) ; and events related to the orthopedic site were the main reason for readmissions (20)(21)(22)(24)(25)29) , ranging from 32.0 to 40.6% in the group of unplanned readmissions.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Readmission from orthopedic surgical site infections: an integrative review

Torres

Turrini

Merighi

et al. 2015

Rev. esc. enferm. USP

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Objective: Characterizing readmissions from orthopedic surgical site infections. Method: An integrative review of literature in the LILACS, IBECS, MEDLINE, Cochrane, SciELO and PUBMED databases, using the descriptors Patient readmission, Wound infection, Cross infection, Orthopedic procedures, Orthopedics. Results: 78 studies were identified and 10 publications were selected. Surgical site infections are the most common cause of unplanned orthopedic readmissions, representing long periods of hospitalization, new surgical procedures and high costs, and greater possibility of subsequent hospitalizations. Most significant predictors have indicated average length of hospitalization, need for intensive care, emergency status at admission, risk of death, age > 65 years, males and higher body mass index. Conclusion: Readmission rates have increasingly become measures of quality and concerns about costs. New studies could involve issues related to indirect costs, specifically social and psychological costs.

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Association Between Facility Surgical Volume and Excess Time in the Hospital After Surgical Resection of Vestibular Schwannomas

Dixon

Moshtaghi

Harris

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceHigh surgical vestibular schwannoma case volume in a medical institution may decrease the risk of adverse outcomes among patients undergoing vestibular schwannoma surgery.ObjectiveTo study the association between surgical vestibular schwannoma case volume and excess time in the hospital after vestibular schwannoma surgery.Design, Setting, and ParticipantsThis cohort study evaluated data from the National Cancer Database from January 1, 2004, through December 31, 2019, on Commission on Cancer–accredited facilities in the US. The hospital-based sample comprised adult patients aged 18 years or older with a vestibular schwannoma treated with surgery.ExposuresFacility case volume, defined as the mean number of surgical vestibular schwannoma cases per year in the 2 years preceding the index case.Main Outcomes and MeasuresThe primary outcome was a composite of prolonged hospital stay (&gt;90th percentile) or 30-day readmission. Risk-adjusted restricted cubic splines were used to model the probability of the outcome according to facility volume. The inflection point (in cases per year) when the declining risk of excess time in the hospital began to plateau was selected as the threshold to define high- and low-volume facilities. Outcomes were compared among patients treated at high- and low-volume facilities, with mixed-effects logistic regression models adjusting for patient sociodemographic characteristics, comorbidities, tumor size, and clustering within facilities. Collected data were analyzed between June 24 and August 31, 2022.ResultsAmong 11 524 eligible patients (mean [SD] age, 50.2 [12.8] years; 53.5% female; 46.5% male) who underwent surgical resection of vestibular schwannoma at 66 reporting facilities, the median length of stay was 4 (IQR, 3-5) days, and 655 patients (5.7%) were readmitted within 30 days. The median case volume was 16 (IQR, 9-26) cases per year. An adjusted restricted cubic spline model identified a downtrending probability of excess time in the hospital with increasing volume. The declining risk of excess time in the hospital began to plateau at a facility volume of 25 cases per year. Surgery at a facility with an annual case volume at or above this threshold was independently associated with a 42% reduction in the odds of excess time in the hospital compared with surgery at a low-volume center (odds ratio, 0.58; 95% CI, 0.44-0.77).Conclusions and RelevanceThis cohort study found that among adults undergoing vestibular schwannoma surgery, a higher facility case volume was associated with a reduced risk of prolonged hospital stay or 30-day readmission. A facility case volume of 25 cases per year may represent a risk-defining threshold.

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Thirty-Day Readmission Rates as a Measure of Quality: Causes of Readmission After Orthopedic Surgeries and Accuracy of Administrative Data

Cited by 44 publications

References 10 publications

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?

Readmission from orthopedic surgical site infections: an integrative review

Association Between Facility Surgical Volume and Excess Time in the Hospital After Surgical Resection of Vestibular Schwannomas

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