Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases

Robert W Westermann; Andrew J Pugely; Zachary Ries; Annunziato Amendola; Christopher T Martin; Yubo Gao; Brian R Wolf

doi:10.1016/j.arthro.2015.03.029

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Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases

Journal article

Peer reviewed

Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases

Robert W Westermann, Andrew J Pugely, Zachary Ries, Annunziato Amendola, Christopher T Martin, Yubo Gao and Brian R Wolf

Arthroscopy, Vol.31(6), pp.1035-1040.e1

06/2015

DOI: 10.1016/j.arthro.2015.03.029

PMID: 26048765

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Abstract

To evaluate the incidence, causes, and risk factors for unplanned 30-day readmission after shoulder and knee arthroscopy. A multicenter, prospective clinic registry, the American College of Surgeons National Surgical Quality Improvement Program, was queried for Current Procedural Terminology codes representing the most common shoulder and knee arthroscopic procedures. Unplanned readmissions within 30 days were evaluated dichotomously, and causes of readmission were identified. Univariate and multivariate logistic regression analyses were used to identify variables predictive of readmission. In total, we identified 15,167 patients who underwent shoulder and knee arthroscopic procedures in 2012. Overall, 136 (0.90%) were readmitted within 30 days, and the rates were similar after shoulder (0.86%) and knee (0.92%) procedures. Readmissions were most common after arthroscopic debridement of the knee (1.56%) and lowest after rotator cuff and labral repairs (0.68%) and cruciate reconstructions (0.78%). The most common causes of readmission were surgical-site infections (37.1%), deep venous thrombosis and pulmonary embolism (17.1%), and postoperative pain (7.1%). Multivariate analysis identified age older than 80 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.5 to 8.1), chronic steroid use (OR, 3.3; 95% CI, 1.5 to 7.2), and elevated American Society of Anesthesiologists class (OR, 4.2; 95% CI, 1.4 to 12.0) as independent risk factors for readmission. The rate of unplanned readmissions within 30 days of shoulder and knee arthroscopic procedures is low, at 0.92%, with wound-related complications being the most common cause. In patients with advanced age, with chronic steroid use, and with chronic systemic disease, the risk of readmission may be higher. These findings may aid in the informed-consent process, patient optimization, and the quality-reporting risk-adjustment process. Level III, prognostic study.

Registries

Multivariate Analysis

United States - epidemiology

Surgical Wound Infection - epidemiology

Prognosis

Prospective Studies

Humans

Middle Aged

Risk Factors

Male

Incidence

Knee Joint - surgery

Shoulder Joint - surgery

Quality Improvement

Pain, Postoperative - epidemiology

Aged, 80 and over

Female

Aged

Retrospective Studies

Patient Readmission - statistics & numerical data

Arthroscopy - adverse effects

Arthroscopy - utilization

Details

Title: Subtitle: Causes and Predictors of 30-Day Readmission After Shoulder and Knee Arthroscopy: An Analysis of 15,167 Cases
Creators: Robert W Westermann - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.. Electronic address: robert-westermann@uiowa.edu
Andrew J Pugely - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Zachary Ries - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Annunziato Amendola - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Christopher T Martin - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Yubo Gao - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Brian R Wolf - Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
Resource Type: Journal article
Publication Details: Arthroscopy, Vol.31(6), pp.1035-1040.e1
DOI: 10.1016/j.arthro.2015.03.029
PMID: 26048765
NLM abbreviation: Arthroscopy
ISSN: 0749-8063
eISSN: 1526-3231
Publisher: Elsevier; United States
Language: English
Date published: 06/2015
Academic Unit: Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science; Internal Medicine; Athletic Training Program
Record Identifier: 9984040018102771

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