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Study highlights risk factors of readmission, longer stay after revision joint arthroplasty
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Results from this study indicated modifiable risk factors for 30-day readmission and extended length of stay should be addressed prior to surgery in patients scheduled for revision joint arthroplasty.
Researchers conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database and identified 4,977 patients who underwent revision knee arthroplasty and 5,135 patients who underwent revision hip arthroplasty. Investigators used International Classification of Diseases, Ninth Revision diagnosis codes to classify procedures as being performed for mechanical issues, loosening, infection, dislocation or fracture.
Investigators compared patient demographics, comorbidities, intraoperative variables, pre-discharge outcomes and 30-day outcomes between the readmitted group and patients who were not readmitted. A multivariate logistic regression model was used to assess severe or minor adverse events pre-discharge and predictors of revision surgery.
Findings showed that among the causes for revision, the most common were due to mechanical issues and loosening. The second most common reasons were for infection, followed by dislocation. Investigators found the readmitted group had a significantly higher percentage of patients who had severe and minor adverse events compared with the non-readmitted group.
According to results of the multivariate analysis, significant predictors of readmission were a severe adverse event prior to discharge, pulmonary disease, stroke and cardiac disease, as well as male sex and an American Society of Anesthesiologists (ASA) class of 3 or 4. A surgical complication was the most common cause for readmission in both the revision hip and knee groups.
Multivariate analysis also showed independent predictors for extended length of stay were infection or fracture etiology relative to mechanical loosening, functional status, high BMI, diabetes and cardiac disease. Other independent factors included stroke, bleeding-causing disorders, an ASA class of 3 or 4, and a history of smoking. ‒ by Monica Jaramillo
Disclosures: Keswani reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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