Low BMI, contaminated wounds may predict reoperation, readmission after elbow arthroplasty
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Low BMI and contaminated wounds are risk factors that may predict unplanned reoperation and readmission after total elbow arthroplasty, according to published results.
Researchers from the University of Texas Southwestern Medical Center used the National Surgical Quality Improvement database to identify 414 patients who underwent total elbow arthroplasty (TEA) for fractures, osteoarthritis or inflammatory arthritis from 2011 to 2017. According to the study, researchers analyzed patient demographics and comorbidities and rates of reoperation and readmission within 30 days after the operation.
“Potential predictors of reoperation and readmission in the model include: age, sex, race, BMI, diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, smoking, bleeding disorders, American Society of Anesthesiologists classification, wound classification, operative time and indication for surgery,” the researchers wrote in the study.
They also compared 30-day rates of reoperation and readmission between patients who underwent TEA for trauma-related injuries vs. OA, hypothesizing that “TEA performed for acute elbow trauma would have higher rates of 30-day readmission and reoperation than TEA for osteoarthritis,” they wrote.
Overall, the rate of unplanned reoperation was 2.4% (10 patients), while the rate of unplanned readmission was 5.1% (21 patients), according to the study.
No differences were found in reoperation or readmission rates between patients who presented with fractures, OA or inflammatory arthritis.
After multiple logistic regression analysis, researchers found patients with low BMI had increased odds of unplanned readmission and patients with wounds classified as “contaminated” or “dirty” had increased odds of unplanned reoperation, the researchers wrote.
“The findings of this study may be useful as prognostic information for patients, families and hospitals managing the expense associated with adverse events after TEA,” they concluded.
Perspective
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Samer S. Hasan, MD, PhD
Total elbow arthroplasty (TEA) is infrequently performed for a broad range of diagnoses including inflammatory arthritis, osteoarthritis and certain elbow fractures and fracture sequelae. Most large outcome studies emanate from a handful of tertiary referral centers so that their findings may not generalize to lower-volume surgeons at community hospitals performing the occasional TEA for fracture or inflammatory arthritis.
In this study, the authors queried a national database over a 6-year period to determine the incidence and predictors of early (30-day) readmissions and reoperations. Only 414 patients underwent TEA over 6 years, which underscores how infrequently TEA is performed relative to hip, knee and shoulder arthroplasty. The authors determined a 5.1% 30-day readmission rate and a 2.4% reoperation rate, comparable to those in other recent database survey studies. Underlying diagnosis did not influence these rates, but contaminated or dirty wounds, functional dependency and a low BMI were associated with increased odds of complication, readmission or reoperation. In addition to providing generalizable prognostic information on the risk of early adverse events following TEA, this study may spur the development of preventive strategies, such as staging the TEA to address contaminated wounds and enhanced nutritional and medical optimization of frail patients prior to elective TEA.
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