title: Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization.
abstract: BACKGROUND
  Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles.
  
  
  OBJECTIVE
  To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures.
  
  
  METHODS
  Retrospective cohort analysis from Kaiser Permanente Southern California Region database.
  
  
  METHODS
  Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes.
  
  
  RESULTS
  From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42-8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ≥ 10 (OR, 4.47, 95% CI = 2.54-7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05-1.19), cancer (OR 3.38, 95% CI = 1.61-7.10), 30-day readmission (OR 3.31, 95% CI = 1.34-8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40-44.17) predicted higher mortality risk.
  
  
  CONCLUSIONS
  After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality.
authors.affiliation: Orthopedic Surgeon at the Anaheim Medical Center in CA. edward.h.yian@kp.org.
authors.forename: Edward
authors.initials: E
authors.lastname: Yian
authors.affiliation: Biostatistician for Research and Evaluation for the Southern California Permanente Medical Group in Pasadena, CA. hui.x.zhou@kp.org.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhou
authors.affiliation: Researcher in Orthopedic Surgery at the Kaiser Permanente Alton/San Canyon Medical Offices in Irvine, CA. ariyon.schreiber@gmail.com.
authors.forename: Ariyon
authors.initials: A
authors.lastname: Schreiber
authors.affiliation: Orthopedic Surgeon at the Anaheim Medical Center in CA. jeffrey.f.sodl@kp.org.
authors.forename: Jeff
authors.initials: J
authors.lastname: Sodl
authors.affiliation: Orthopedic Surgeon at the Harbor City Medical Center in CA. navarro.ortho@gmail.com.
authors.forename: Ron
authors.initials: R
authors.lastname: Navarro
authors.affiliation: Orthopedist at the San Diego Medical Center in CA. anshuman.x.singh@kp.org.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Singh
authors.affiliation: Fellow Physician in Orthopedic Surgery at the Kaiser Permanente Alton/San Canyon Medical Offices in Irvine, CA. nikita.bezrukov@kp.org.
authors.forename: Nikita
authors.initials: N
authors.lastname: Bezrukov
mesh_terms: D000368:Aged; D002140:California; D003153:Community Health Services; D016208:Databases, Factual; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006811:Humerus / Q000293:injuries*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008485:Medical Audit; D009026:Mortality / Q000639:trends*; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment
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