Development of a Novel Prospective Model to Predict Unplanned 90-Day Readmissions After Total Hip Arthroplasty

被引:5
作者
Korvink, Michael [1 ]
Hung, Chun Wai [2 ]
Wong, Peter K. [3 ]
Martin, John [1 ]
Halawi, Mohamad J. [2 ,4 ]
机构
[1] Premier Inc, ITS Data Sci, Charlotte, NC USA
[2] Baylor Coll Med, Dept Orthoped Surg, Houston, TX USA
[3] St Lukes Hlth, Dept Performance & Org Excellence, CHI Texas Div, Houston, TX USA
[4] Baylor Coll Med, Dept Orthopaed Surg, 7200 Cambridge St,Suite 10A, Houston, TX 77030 USA
关键词
total hip arthroplasty; risk strati fication; predictive modeling; 90-day readmissions; mixed-effect logistic regression; TOTAL JOINT ARTHROPLASTY; BUNDLED PAYMENTS; OPIOID USE; RISK; REOPERATION; REPLACEMENT;
D O I
10.1016/j.arth.2022.07.017
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: For hospitals participating in bundled payment programs, unplanned readmissions after surgery are often termed "bundle busters." The aim of this study was to develop the framework for a prospective model to predict 90-day unplanned readmissions after elective primary total hip arthroplasty (THA) at a macroscopic hospital-based level. Methods: A national, all-payer, inpatient claims and cost accounting database was used. A mixed-effect logistic regression model measuring the association of unplanned 90-day readmissions with a number of patient-level and hospital-level characteristics was constructed. Results: Using 427,809 unique inpatient THA encounters, 77 significant risk factors across 5 domains (ie, comorbidities, demographics, surgical history, active medications, and intraoperative factors) were identified. The highest frequency domain was comorbidities (64/100) with malignancies (odds ratio [OR] 2.26), disorders of the respiratory system (OR 1.75), epilepsy (OR 1.5), and psychotic disorders (OR 1.5), being the most predictive. Other notable risk factors identified by the model were the use of opioid analgesics (OR 7.3), Medicaid coverage (OR 1.8), antidepressants (OR 1.6), and blood-related medications (OR 1.6). The model produced an area under the curve of 0.715. Conclusion: We developed a novel model to predict unplanned 90-day readmissions after elective primary THA. Fifteen percent of the risk factors are potentially modifiable such as use of tranexamic acid, spinal anesthesia, and opioid medications. Given the complexity of the factors involved, hospital systems with vested interest should consider incorporating some of the findings from this study in the form of electronic medical records predictive analytics tools to offer clinicians with real-time actionable data. Published by Elsevier Inc.
引用
收藏
页码:124 / 128
页数:5
相关论文
共 50 条
[31]   Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture [J].
Rui He ;
Guoyou Wang ;
Ting Li ;
Huarui Shen .
BMC Geriatrics, 22
[32]   Same-day discharge is not inferior to longer length of in-hospital stay for 90-day readmissions following shoulder arthroplasty [J].
Kramer, Jonathan D. ;
Chan, Priscilla H. ;
Prentice, Heather A. ;
Hatch, Joshua ;
Dillon, Mark T. ;
Navarro, Ronald A. .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2020, 29 (05) :898-905
[33]   Implementation of a Total Hip Arthroplasty Care Pathway at a High-Volume Health System: Effect on Length of Stay, Discharge Disposition, and 90-Day Complications [J].
Featherall, Joseph ;
Brigati, David P. ;
Faour, Mhamad ;
Messner, William ;
Higuera, Carlos A. .
JOURNAL OF ARTHROPLASTY, 2018, 33 (06) :1675-1680
[34]   Incision site fat thickness and 90-day complications for direct anterior and posterior approach total hip arthroplasty [J].
Sprowls, Gregory R. ;
Allen, Bryce C. ;
Lundquist, Kathleen F. ;
Sager, Lauren N. ;
Barnett, Clint D. .
HIP INTERNATIONAL, 2022, 32 (04) :431-437
[35]   Prediction of 90-day mortality after total hip arthroplasty A SIMPLIFIED AND EXTERNALLY VALIDATED MODEL BASED ON OBSERVATIONAL REGISTRY DATA FROM SWEDEN, ENGLAND, AND WALES [J].
Garland, A. ;
Bulow, E. ;
Lenguerrand, E. ;
Blom, A. ;
Wilkinson, M. ;
Sayers, A. ;
Rolfson, O. ;
Hailer, N. P. .
BONE & JOINT JOURNAL, 2021, 103B (03) :469-478
[36]   Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty [J].
Jorgensen, C. C. ;
Kehlet, H. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2017, 61 (04) :436-444
[37]   Unplanned intubation after total hip and total knee arthroplasty: Assessing preoperative risk factors [J].
Harvey, Jackson P. ;
Foy, Michael P. ;
Sood, Anshum ;
Gonzalez, Mark H. .
JOURNAL OF ORTHOPAEDICS, 2022, 29 :86-91
[38]   Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study [J].
Kulshrestha, Vikas ;
Sood, Munish ;
Kumar, Santhosh ;
Sood, Nikhil ;
Kumar, Pradeep ;
Padhi, Prashanth P. .
CLINICS IN ORTHOPEDIC SURGERY, 2022, 14 (01) :56-68
[39]   Patient Factors Predict Periprosthetic Fractures After Revision Total Hip Arthroplasty [J].
Singh, Jasvinder A. ;
Jensen, Matthew R. ;
Lewallen, David G. .
JOURNAL OF ARTHROPLASTY, 2012, 27 (08) :1507-1512
[40]   Risk-Adjusted Cost Performance for 90-Day Total Hip Arthroplasty Episodes: Comparing US Hospitals Nationwide Before CJR [J].
Schilling, Peter L. ;
He, Jason ;
Chen, Sarah ;
Placzek, Hilary ;
Bini, Stefano A. .
JOURNAL OF ARTHROPLASTY, 2020, 35 (12) :3452-3463