title: Predictors of Hospital Readmission After Total Shoulder Arthroplasty.
abstract: The study was conducted to determine the incidence rate, risk factors, and postoperative conditions associated with 30-day readmission after total shoulder arthroplasty (TSA). A total of 3547 patients who underwent primary TSA were identified from the 2011-2013 American College of Surgeons National Surgical Quality Improvement Program. The 30-day readmission rate was 2.9%. The only preoperative predictors of hospital readmission were American Society of Anesthesiologists classification of 3 or greater (odds ratio, 2.16; 95% confidence interval, 1.30-3.61) and a history of cardiac disease (odds ratio, 2.13; 95% confidence interval, 1.05-4.31). Of patients with any perioperative complications, 42 (34%) were readmitted, and the presence of any complication increased the risk of readmission (odds ratio, 28.95; 95% confidence interval, 18.44-45.46). Periprosthetic joint infection, myocardial infarction, pulmonary embolism, deep venous thrombosis, and pneumonia were significant predictors of hospital readmission after TSA (P<.0001). The incidence of hospital readmission after TSA peaked within the first 5 days after discharge, and 26%, 32%, and 55% of all hospital readmissions occurred by postoperative days 5, 7, and 14, respectively. Pre-operative medical optimization to reduce the rates of postoperative complications, such as periprosthetic joint infection, myocardial infarction, pulmonary embolism, deep venous thrombosis, pneumonia, and urinary tract infection, are likely to decrease the need for subsequent readmission. Patients should be counseled about these risk factors preoperatively. [Orthopedics. 2017; 40(1):e1-e10.].
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Belmont
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Kusnezov
authors.forename: John C
authors.initials: JC
authors.lastname: Dunn
authors.forename: Julia O
authors.initials: JO
authors.lastname: Bader
authors.forename: Kelly
authors.initials: K
authors.lastname: Kilcoyne
authors.forename: Brian R
authors.initials: BR
authors.lastname: Waterman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000453:epidemiology; D000072228:Arthroplasty, Replacement, Shoulder; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D016459:Prosthesis-Related Infections / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000453:epidemiology; D058996:Quality Improvement; D012307:Risk Factors; D012782:Shoulder / Q000601:surgery; D012785:Shoulder Joint / Q000601:surgery; D000072227:Shoulder Prosthesis; D013530:Surgical Wound Infection / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology