Higher Patient Complexities are Associated with Increased Length of Stay, Complications, and Readmissions After Total Hip Arthroplasty

Author(s):  
Sai Guntaka ◽  
John Tarazi ◽  
Zhongming Chen ◽  
Rushabh Vakharia ◽  
Michael Mont ◽  
...  

Introduction: There is an increased incidence of complex patients undergoing total hip arthroplasty (THA), which demands a rigorous preoperative, intraoperative, and postoperative assessment. It is important how increases in patient complexity impact a variety of patient outcomes. Therefore, the purpose of our study is to determine if a higher Elixhauser Comorbidity Index (ECI), a measure of patient complexity, is correlated with: 1) longer hospital length of stay; 2) increased 90-day medical complications; 3) higher 90-day readmissions; and 4) greater two-year implant-related complications following primary THA. Materials and Methods: Patients undergoing primary THA from January 1, 2004 to December 31, 2015 were queried from the Medicare Standard Analytical Files using the International Classification of Disease, ninth revision (ICD-9) procedure code 81.51. The queried patients (387,831) were filtered by ECI scores of 1 to 5. Patients who have ECI scores of 2 to 5 represented the study cohorts and were matched according to age and sex to patients who have the lowest ECI score (ECI of 1). All cohorts were longitudinally followed to assess and compare hospital length of stay, 90-day medical complications, 90-day readmissions, and two-year implant-related complications. We compared odds-ratios (OR), 95% confidence intervals (95% CI), and p-values using logistic regression analyses and Welch’s t-tests. Results: Patients who have ECI scores greater than 1 had higher hospital length of stay (p<0.001), 90-day medical complications (p<0.001), 90-day readmissions (p<0.001), and two-year implant-related complications (p<0.001). Patients who have an ECI score of 2 (1.26, 95% CI: 1.20–1.32), ECI of 3 (1.61, 95% CI: 1.53–1.69), ECI of 4 (2.05, 95% CI: 1.95–2.14), and ECI of 5 (2.32, 95% CI: 2.21–2.43) had an increasing trend for readmissions, with higher ECI scores correlating with greater odds of readmission following primary THA. Two-year implant-related complications also showed a similar increasing trend with greater patient complexity. Patients who had an ECI score of 5 (2.54, 95% CI: 2.39–2.69) had more implant-related complications compared to patients who had an ECI score of 2 (1.39, 95% CI:1.31–1.48). Conclusion: The results of this study illustrate that a higher Elixhauser-Comorbidity Index is an independent risk factor for longer hospital length of stay, higher 90-day medical complications, greater 90-day readmissions, and increased two-year implant-related complications following primary THA. This study is important as it further defines and heightens awareness of adverse events for complex patients undergoing this procedure. Future studies can examine if these events can potentially be mitigated through reductions in ECI scores prior to surgery and increased incentives for the healthcare team.

2016 ◽  
Vol 31 (11) ◽  
pp. 2426-2431 ◽  
Author(s):  
Aakash Keswani ◽  
Christina Beck ◽  
Kristen M. Meier ◽  
Adam Fields ◽  
Michael J. Bronson ◽  
...  

2016 ◽  
Vol 11 (5) ◽  
pp. 2986-2987
Author(s):  
Georgios I. Tagarakis ◽  
Costas Dikeos ◽  
Nikolaos Tsilimingas ◽  
Charalampos Tsairidis ◽  
Fani Tsolaki ◽  
...  

Aim. To evaluate the Greek Diagnosis Related Groups(DRG's)system in regard to the procedure of total hip arthroplasty. Methods. In a tertiary university orthopedics department implementing clinical protocols we recruited 75 consecutive patients planned to undergototal hip arthroplasty. Indicators of quality and performance were rates of mortality, pulmonary embolism, trauma dehiscence, disarticulation and readmission. Results. All rates of performance were excellent and equal to zero. The mean length of stay was almost identical to the one predicted by the Greek DRG's. Conclusions. Clinical protocols are connected with good clinical results. The predicted by the Greek DRG's hospital length of stay for total hip arthroplasty lies within pragmatic limits. 


2017 ◽  
Vol 32 (7) ◽  
pp. 2318
Author(s):  
Borja de la Hera ◽  
María Alvarez-Postigo ◽  
Renato Delfino ◽  
Diego Garcia-Garcia ◽  
Maria J. Rayo

2015 ◽  
Vol 30 (4) ◽  
pp. 555-558 ◽  
Author(s):  
Mohamad J. Halawi ◽  
Tyler J. Vovos ◽  
Cindy L. Green ◽  
Samuel S. Wellman ◽  
David E. Attarian ◽  
...  

2020 ◽  
Vol 04 (01) ◽  
pp. 007-014
Author(s):  
Joseph E. Tanenbaum ◽  
Thomas T. Bomberger ◽  
Derrick M. Knapik ◽  
Steven J. Fitzgerald ◽  
Nihar S. Shah ◽  
...  

AbstractThe relationship between preoperative hyponatremia and 30-day outcomes following total hip arthroplasty (THA) is currently unknown. The present study used prospectively collected data to quantify the association between preoperative hyponatremia and odds of major morbidity (MM), longer length of stay, readmission, and reoperation within 30 days following THA. Patients who underwent THA between 2012 and 2014 were identified in the National Surgical Quality Improvement Program database using validated Current Procedural Terminology codes. Patients were included if they were either normonatremic or hyponatremic preoperatively. The outcome measures in this study were 30-day MM, hospital length of stay, 30-day readmission, and 30-day reoperation. A unique multivariable logistic regression model was used for each outcome to identify statistically significant associations between hyponatremia and the outcome of interest after adjusting for covariates. From 2012 to 2014, 59,236 THA procedures were recorded in National Surgical Quality Improvement Program, of which 55,611 patients were normonatremic and 3,051 patients were hyponatremic. After adjusting for covariates, preoperative hyponatremia was significantly associated with increased odds of MM (odds ratio [OR] = 1.14; 99% confidence interval [CI]: 1.01–1.30), 30-day reoperation (OR = 1.18; 99% CI: 1.02–1.36), and longer hospital length of stay (OR = 1.20; 99% CI: 1.13–1.27). Hyponatremia was not significantly associated with greater odds of 30-day readmission (OR = 0.91; 99% CI: 0.82–1.01). Preoperative hyponatremia was significantly associated with adverse 30-day outcomes following THA. As the U.S. health care system continues to transition toward value-based reimbursement that emphasizes health care quality, the results of the present study can be used to improve patient selection and preoperative counseling.


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