Thirty-day readmission following total hip and knee arthroplasty - a preliminary single institution predictive model.
We sought to identify demographic or care process variables associated with increased 30-day readmission within the total hip and knee arthroplasty patient population. Using this information, we generated a model to predict 30-day readmission risk following total hip and knee arthroplasty procedures. Longer index length of stay, discharge disposition to a nursing facility, blood transfusion, general anesthesia, anemia, anticoagulation status prior to index admission, and Charlson Comorbidity Index greater than 2 were identified as independent risk factors for readmission. Care process factors during the hospital stay appear to have a large predictive value for 30-day readmission. Specific comorbidities and patient demographic factors showed less significance. The predictive nomogram constructed for primary total joint readmission had a bootstrap-corrected concordance statistic of 0.76.
Department of Orthopaedic surgery, Vanderbilt University Medical Center. Electronic address: nate.mesko@gmail.com.
Nathan W
NW
Mesko
Department of Orthopaedic Surgery Cleveland Clinic, Adult Reconstruction Section, Cleveland Clinic, Ohio.
Keith R
KR
Bachmann
Department of Orthopaedic Surgery Cleveland Clinic, Adult Reconstruction Section, Cleveland Clinic, Ohio.
David
D
Kovacevic
Department of Orthopaedic Surgery Cleveland Clinic, Adult Reconstruction Section, Cleveland Clinic, Ohio.
Mary E
ME
LoGrasso
Lerner Research Institute, Cleveland, Ohio.
Colin
C
O'Rourke
Department of Orthopaedic Surgery Cleveland Clinic, Adult Reconstruction Section, Cleveland Clinic, Ohio.
Mark I
MI
Froimson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000706:statistics & numerical data*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000706:statistics & numerical data*; D001803:Blood Transfusion; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
30-day readmission; risk stratification; total joint arthroplasty; value-based healthcare