Low incidence of unplanned admission found after hip arthroscopy
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Patients had a low incidence of 30-day unplanned admission after hip arthroscopy, with chronic corticosteroid use, perioperative transfusions and greater BMI identified as independent risk factors, according to published results.
Michael J. Salata , MD, and colleagues used CPT, ICD-9 and ICD-10 codes to identify 1,931 patients who underwent hip arthroscopy in the American College of Surgeons National Surgical Quality Improvement Program database. Researchers compared demographics, comorbidities, preoperative laboratory values, surgical details and postoperative outcomes of patients with planned and unplanned admissions after hip arthroscopy.
Within 30 days of the index procedure, results showed an unplanned admission rate of 0.9%, with a median time to unplanned admission of 14.5 days. Researchers found surgical site infection, wound complications and thromboembolic events as the most common reasons for admission. According to results, 22.2% of patients required reoperation and 39% of patients were readmitted for reasons unrelated to the index hip arthroscopy procedure. Multivariate analysis showed an increased risk for unplanned admission was independently associated with chronic corticosteroid use, perioperative blood transfusion and increasing BMI.
“Evaluation of patients’ incisions within the first week to 10 days and some form of thromboembolic prophylaxis would seem to be ways to attempt to prevent these most common reasons for readmission,” Salata told Healio Orthopedics. – by Casey Tingle
Disclosures: Salata reports he received personal fees from Stryker Corporation. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Aaron J. Krych, MD
In the United States, hip arthroscopy procedures have been steadily growing with demonstration of good to excellent outcomes and relatively rare complications. However, given the elective nature of most hip arthroscopy procedures, it is critical to identify potential risks — especially modifiable ones — to minimize complications and maximize patient outcomes. The current authors utilized the National Surgical Quality Improvement Program database to determine that unplanned admissions within 30 days of surgery were less than 1% for 1,931 hip arthroscopy cases performed between 2011 to 2016.
Overall, I find this data reassuring and underscores that hip arthroscopy can be safely performed as an outpatient procedure for the vast majority of patients. The unplanned admissions related to the actual hip procedure included surgical site infections, wound complications and thromboembolic events, with independent risk factors identified including elevated BMI, chronic corticosteroid use and perioperative transfusions. In my opinion, elevated BMI is a potentially modifiable risk factor that can and should be addressed prior to surgery, not only for lower complications, but also to optimize patient outcome. In addition, these findings suggest that medically complicated patients may benefit from a multidisciplinary care team, with decision-making for possible overnight observation following hip arthroscopy dependent on individual circumstances.
Professor of orthopedics
Rochester, Minnesota
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