背景:随着对全膝关节置换术(TKA)的需求升级,90天再入院已成为当前基于价值的医疗保健系统的紧迫临床和经济问题。因此,医疗保健提供者一直专注于估计再入院患者的风险水平;然而,尚不清楚特定因素是否与不同类型的并发症相关(即,医疗或骨科相关)导致再入院。因此,本研究旨在:(1)确定总体,与医疗有关的,和骨科相关的90天再入院率;(2)建立风险因素的预测模型,影响总体,与医疗有关的,和骨科相关的TKA术后90天再入院。
方法:纳入了2016年至2020年在美国大型三级学术中心进行的原发性单侧TKAs的前瞻性队列(n=10,521例患者)。计划外的再入院进行单独审查,以确定其主要原因,无论是医疗还是骨科。骨科相关的再入院是影响关节的特定并发症,假肢,或手术伤口。医疗再入院是由于需要医疗管理的任何其他原因。使用多变量逻辑回归模型来调查预先指定的危险因素与90天再入院之间的关联。以及医疗/骨科相关的独立再入院。
结果:总体而言,90日再入院率为6.7%(n=704).这些再入院的82%以上是由于医疗相关原因(n=580),其余18%为骨科相关(n=124)再入院。90天再入院模型的AUC为0.68(95%CI[置信区间]:0.67至0.70)。性,吸烟,停留时间(LOS)出院处置(DD)与骨科再入院有关,而年龄,性别,种族,Charlson合并症指数(CCI),保险,手术日,阿片类药物过量风险(NARX)评分,LOS,和DD与医学相关的90天再入院相关.
结论:TKA后医疗相关的再入院比骨科相关的再入院更为普遍。通过成功构建和验证多个90天再入院预测模型,我们强调了医疗和骨科相关再入院的不同风险特征.这强调了细微差别的必要性,针对患者的风险分层和预防措施。
BACKGROUND: As the demand for total knee arthroplasty (TKA) escalates, 90-day readmissions have emerged as a pressing clinical and economic concern for the current value-based health care system. Consequently, health care providers have focused on estimating the risk levels of readmitted patients; however, it is unknown if specific factors are associated with different types of complications (ie, medical or
orthopaedic-related) that lead to readmissions. Therefore, this study aimed to (1) determine the overall, medical-related, and
orthopaedic-related 90-day readmission rate and (2) develop a predictive model for risk factors affecting overall, medical-related, and orthopaedic-related 90-day readmissions following TKA.
METHODS: A prospective cohort of primary unilateral TKAs performed at a large tertiary academic center in the United States from 2016 to 2020 was included (n = 10,521 patients). Unplanned readmissions were reviewed individually to determine their primary cause, either medical or orthopaedic-related.
Orthopaedic-related readmissions were specific complications affecting the joint, prosthesis, or surgical wound. Medical readmissions were due to any other cause requiring medical management. Multivariable logistic regression models were used to investigate associations between prespecified risk factors and 90-day readmissions, as well as medical and orthopaedic-related readmissions independently.
RESULTS: Overall, the rate of 90-day readmissions was 6.7% (n = 704). Over 82% of these readmissions were due to medical-related causes (n = 580), with the remaining 18% being orthopaedic-related (n = 124) readmissions. The area under the curve for the 90-day readmission model was 0.68 (95% confidence interval: 0.67 to 0.70). Sex, smoking, length of stay, and discharge disposition were associated with
orthopaedic readmission, while age, sex, race, the Charlson Comorbidity Index, insurance, surgery day, opioid overdose risk score, length of stay, and discharge disposition were associated with medical-related 90-day readmissions.
CONCLUSIONS: Medical-related readmissions after TKA are more prevalent than
orthopaedic-related readmissions. Through successfully constructing and validating multiple 90-day readmission predictive models, we highlight the distinct risk profiles for medical and orthopaedic-related readmissions. This emphasizes the necessity for nuanced, patient-specific risk stratification and preventive measures.