title: Management of Modifiable Risk Factors Prior to Primary Hip and Knee Arthroplasty: A Readmission Risk Assessment Tool.
abstract: BACKGROUND
  Preoperative risk stratification and optimization of preoperative care may be helpful in reducing readmission rates after primary total joint arthroplasty. Assessment of the predictive value of individual modifiable risk factors without a tool to assess cumulative risk may not provide proper risk stratification of patients with regard to potential readmissions. As part of a Perioperative Orthopaedic Surgical Home model, we developed a scoring system, the Readmission Risk Assessment Tool (RRAT), which allows for risk stratification in patients undergoing elective primary total joint arthroplasty at our institution. The purpose of this study was to analyze the relationship between the RRAT score and readmission after primary hip or knee arthroplasty.
  
  
  METHODS
  The RRAT, which is scored incrementally on the basis of the number and severity of modifiable comorbidities, was used to generate readmission scores for a cohort of 207 readmitted patients and two cohorts (one random and one age-matched) of 234 non-readmitted patients each. Regression analysis was performed to assess the strength of association of individual risk factors and the RRAT score with readmissions. We also calculated the odds and odds ratio (OR) at each RRAT score level to identify patients with relatively higher risk of readmission.
  
  
  RESULTS
  There were 207 (2.08%) readmissions among 9930 patients over a six-year period (2008 through 2013). Surgical site infection was the most common cause of readmission (ninety-three cases, 45%). The median RRAT scores were 3 (IQR [interquartile range], 1 to 4) and 1 (IQR, 0 to 2) for readmitted and non-readmitted groups, respectively. An RRAT score of ≥3 was significantly associated with higher odds of readmission.
  
  
  CONCLUSIONS
  Population health management, cost-effective care, and optimization of outcomes to maximize value are the new maxims for health-care delivery in the United States. We found that the RRAT score had a significant association with readmission after joint arthroplasty and could potentially be a clinically useful tool for risk mitigation.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Sreevathsa
authors.initials: S
authors.lastname: Boraiah
authors.affiliation: Department of Biostatistics, New York University, 650 1st Avenue #556, New York, NY 10016.
authors.forename: LiJin
authors.initials: L
authors.lastname: Joo
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Ifeoma A
authors.initials: IA
authors.lastname: Inneh
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Parthiv
authors.initials: P
authors.lastname: Rathod
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
authors.forename: Morteza
authors.initials: M
authors.lastname: Meftah
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Philip
authors.initials: P
authors.lastname: Band
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R. Iorio: Richard.iorio@nyumc.org.
authors.forename: Richard
authors.initials: R
authors.lastname: Iorio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D000066491:Clinical Decision-Making / Q000379:methods*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors