Incidence, Causes, and Timing of 30-Day Readmission following Total Hip Arthroplasty

2019 ◽  
Vol 03 (03) ◽  
pp. 118-123
Author(s):  
Gannon L. Curtis ◽  
Michael Jawad ◽  
Linsen T. Samuel ◽  
Carlos A. Higuera-Rueda ◽  
Bryan E. Little ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Linear Regression Analysis ◽  
Surgical Site Infections ◽  
Cardiovascular Complications ◽  
Wound Complications ◽  
Improvement Program ◽  
Gastrointestinal Complications ◽  
Total Hip ◽  
Common Causes

AbstractUnplanned readmissions are associated with increased financial burdens. It is important to understand why they occur and how to reduce them. This study identifies incidences, trends, causes, and timing of 30-day readmissions after total hip arthroplasty (THA). Primary THA cases from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database were identified (n = 122,451). Fractures (n = 3,990), nonelective surgery (n = 1,715), and bilateral THA (n = 730) were excluded, leaving 116,016 cases. Linear regression analysis determined readmission trends overtime. The readmission rate after THA from 2012 to 16 was 3.32%, which significantly decreased during this time (p = 0.022). The top five causes of readmission included musculoskeletal complications (14.8%), deep surgical site infections (SSI; 11.1%), non-SSI infections (10.8%), gastrointestinal complications (GI; 7.5%), and cardiovascular complications (CV; 7.0%). The most common cause of readmission during week 1 was non-SSI infections (13.0%), week 2 was musculoskeletal complications (16%), week 3 was deep SSI (18.4%), and week 4 was deep SSI (18.6%). Causes of readmission that significantly decreased (p < 0.05) from week 1 to 4 include CV complications, GI complications, non-SSI infections, pain, and respiratory complications. In contrast, causes that significantly increased during this time included deep SSI, prosthesis complications, superficial SSI, and wound complications. Readmissions following THA significantly declined from 2012 to 2016. The most common causes of readmission were musculoskeletal complications, deep SSI, non-SSI infections, GI complications, and CV complications. Interestingly, the most common causes of readmission changed from week to week. These findings may help to develop policies to prevent readmissions following THA.

Reporting Surgical Site Infections Following Primary and Revision Hip Arthroplasty— One Size Does Not Fit All

2011 ◽  
Vol 32 (3) ◽  
pp. 296-297 ◽  
Author(s):  
LJ Worth ◽  
AL Bull ◽  
MJ Richards
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Risk Index ◽  
Surgical Site Infections ◽  
Revision Hip Arthroplasty ◽  
Total Hip ◽  
Clinical Phenomenon ◽  
Using Data ◽  
Healthcare Associated ◽  
Current Risk

The risk of surgical site infection (SSI) is greater after revision hip arthroplasty than after primary procedures. While this is accepted as a clinical phenomenon, standardized surveillance strategies for healthcare-associated infections, including SSIs, do not currently take this into consideration. Most notably, the National Nosocomial Infections Surveillance (NNIS) risk index for stratification does not differentiate between primary and revision surgeries. Using data from a single US center, Leekha et al. recently demonstrated that the risk for SSI was almost twice as high after revision total hip arthroplasty when compared to primary total hip arthroplasty and that risk was even greater when deep incisional or organ/space infections were analyzed. The objective of this study was to compare SSI rates following primary and revision hip arthroplasty in a much larger Australian population to determine whether differences are accounted for by current risk indexing.

Duration of surgery affects the risk of complications following total hip arthroplasty

2019 ◽  
Vol 101-B (6_Supple_B) ◽  
pp. 51-56
Author(s):  
L. L. Nowak ◽  
E. H. Schemitsch
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Operating Time ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Major Complications ◽  
Duration Of Surgery ◽  
American College Of Surgeons ◽  
Multivariable Regression

Aims The aim of this study was to assess the influence of operating time on 30-day complications following total hip arthroplasty (THA). Patients and Methods We identified patients aged 18 years and older who underwent THA between 2006 and 2016 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We identified 131 361 patients, with a mean age of 65 years (sd 12), who underwent THA. We used multivariable regression to determine if the rate of complications and re-admissions was related to the operating time, while adjusting for relevant covariables. Results The mean operating time decreased from 118.3 minutes (29.0 to 217.0) in 2006, to 89.6 minutes (20.0 to 240.0) in 2016. After adjustment for covariables, operating times of between 90 and 119 minutes increased the risk of minor complications by 1.2 (95% confidence interval (CI) 1.1 to 1.3), while operating times of between 120 and 179 minutes increased the risk of major complications by 1.4 (95% CI 1.3 to 1.6) and minor complications by 1.4 (95% CI 1.2 to 1.5), and operating times of 180 minutes or more increased the risk of major complications by 2.1 (95% CI 1.8 to 2.6) and minor complications by 1.9 (95% CI 1.6 to 2.3). There was no difference in the overall risk of complications for operating times of between 20 and 39, 40 and 59, or 60 and 89 minutes (p > 0.05). Operating times of between 40 and 59 minutes decreased the risk of re-admission by 0.88 (95% CI 0.79 to 0.97), while operating times of between 120 and 179 minutes, and of 180 minutes or more, increased the risk of re-admission by 1.2 (95% CI 1.1 to 1.3) and 1.6 (95% CI 1.3 to 1.8), respectively. Conclusion These findings suggest that an operating time of more than 90 minutes may be an independent predictor of major and minor complications, as well as re-admission, following THA, and that an operating time of between 40 and 90 minutes may be ideal. Prospective studies are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(6 Supple B):51–56.

Are there more wound complications or infections with direct anterior approach total hip arthroplasty?

2018 ◽  
Vol 28 (6) ◽  
pp. 591-598 ◽  
Author(s):  
Christophe Tissot ◽  
Matthias Vautrin ◽  
Anais Luyet ◽  
Olivier Borens
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Wound Complication ◽  
Wound Complications ◽  
Obese Patients ◽  
Total Hip ◽  
Delayed Onset

Introduction: Compared to a lateral or posterior approach (PA), the direct anterior approach (DAA) does permit a better muscle preservation for total hip arthroplasty (THA). However, there is concern whether this advantage come with increased wound complication and infection leading to reoperation or sometimes major procedures. Method: We retrospectively reviewed all patients who underwent primary THA through the PA between January 2009 and April 2013 ( n = 796) and through the DAA between January 2011 and April 2013 ( n = 399) at our institution with a minimum of 2 years follow up regarding all wound complications and all infections. Results: Of the 796 patients in the PA group, there were 6 wound complications leading to reoperation and 6 infections; 4 early and 2 delayed onset. Among the infected cases, one was obese (body mass index [BMI] >30 kg/m2). Two procedures were teaching-based. Of the 399 patients in the DAA group, there were three dehiscences leading to reoperation, two of which were in obese patients. 6 infections were also found; 4 with early and 2 with delayed onset. Of the infected cases, three were obese. 4 procedures were teaching-based. Conclusion: In our series of patients undergoing THA, the DAA did not increase the rates of either wound complications leading to reoperation nor early or delayed infection compared to the PA.

scholarly journals Octyl-2-cyanoacrylate tissue adhesive without subcuticular suture for wound closure after total hip arthroplasty: a prospective observational study on thirty-two cases with controls for 3 months follow-up

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Li-Shen Wang ◽  
Xin-Yu Wang ◽  
Hao-tian Tu ◽  
Yi-Fan Huang ◽  
Xin Qi ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Tissue Adhesive ◽  
Wound Complications ◽  
Subcuticular Suture ◽  
Total Hip ◽  
Skin Staples ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Whether using tissue adhesive alone after subcutaneous suture can close the skin incision with safety as well as cosmetic appearance after total hip arthroplasty was not clear. Methods A prospective study was conducted. The same surgical methods were consistent throughout the entire study. After implanting prosthesis, the joint capsule was reconstructed. Fascial and subcutaneous layer were respectively closed by continuous running barbed suture. Patients were randomized allocated to group A with octyl-2-cyanoacrylate tissue adhesive alone, to group B with tissue adhesive after continuous subcuticular suture, or to group C with skin staples. Time of closure, drainage, pain, wound complications, and cosmesis were compared. All data were analyzed statistically. Results There was no significant difference in drainage, Visual Analog Scale score or early wound complications between the three groups. However, there was significant difference in time of closure (P = 0.013). In pairwise comparison, time of closure in groups A and B was significantly longer than those in group C (P = 0.001 and P = 0.023, respectively); time of closure in group A was significantly shorter than those in group B (P = 0.003). Patient and Observer Scar Assessment Scale total scores were not significantly different at 6 weeks and 3 months postoperatively (P = 0.078 and P = 0.284, respectively). Conclusion Tissue adhesive without subcuticular suture was similar with a combination of subcuticular suture and tissue adhesive as well skin staples in terms of safety and cosmetic appearance after total hip arthroplasty.

Revision of an infected total hip arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 547-551 ◽  
Author(s):  
A. T. Malik ◽  
M. Li ◽  
T. J. Scharschmidt ◽  
S. N. Khan
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Risk Adjustment ◽  
International Classification Of Diseases ◽  
Improvement Program ◽  
Bundled Payment ◽  
Total Hip ◽  
Revision Tha ◽  
Icd 10 ◽  
Aseptic Revision

AimsThe aim of this study was to investigate the differences in 30-day outcomes between patients undergoing revision for an infected total hip arthroplasty (THA) compared with an aseptic revision THA.Patients and MethodsThis was a retrospective review of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, between 2012 and 2017, using Current Procedural Terminology (CPT) codes for patients undergoing a revision THA (27134, 27137, 27138). International Classification of Diseases Ninth Revision/Tenth Revision (ICD-9-CM, ICD-10-CM) diagnosis codes for infection of an implant or device were used to identify patients undergoing an infected revision THA. CPT-27132 coupled with ICD-9-CM/ICD-10-CM codes for infection were used to identify patients undergoing a two-stage revision. A total of 13 556 patients were included; 1606 (11.8%) underwent a revision THA due to infection and there were 11 951 (88.2%) aseptic revisions.ResultsPatients undergoing an infected revision had a significantly greater length of stay of more than three days (p < 0.001), higher odds of any 30-day complication (p < 0.001), readmission within 30 days (p < 0.001), 30-day reoperations (p < 0.001), and discharge to a destination other than the patient’s home (p < 0.001).ConclusionThe findings suggest the need for enhanced risk adjustment based on the indication of revision THA prior to setting prices in bundled payment models of total joint arthroplasty. This risk adjustment should be used to reduce the chance of financial disincentives in clinical practice. Cite this article: Bone Joint J 2019;101-B:547–551.

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