Objective: Total joint arthroplasty (TJA) is an effective surgical procedure for patients with end-stage osteoarthritis who have failed conservative treatments, demonstrating significant pain relief and improved physical function. Despite the clinical success of TJA, unplanned readmissions to hospitals after discharge are common, costly, and often preventable. This study aimed to determine the rates, reasons, and risk factors for readmission after TJA. Material and Methods: In this descriptive, retrospective study, we analyzed data from an electronic medical database for all patients who underwent total hip arthroplasty and total knee arthroplasty at one institution from January 2017 to July 2018. A total of 440 patients were included. Bivariate logistic regression was used to determine the risk factors of readmission within one year. Results: The readmission rate was 34.3% within one year. The most common reasons for readmission were pain related to the surgical procedure, the limitation of movements, and swelling at the surgical site. Other reasons were respiratory problems and cough, sputum and fever resulting in infectious complications in the current study. Furthermore, logistic regression analysis showed that patients with some comorbidities (rheumatoid arthritis, venous insufficiency, chronic obstructive pulmonary disease, atherosclerotic heart disease and, Alzheimer's disease) were found to have a higher risk of readmission within one year of discharge. Conclusion: The high readmission rates commonly is due to postoperative problems associated with TJA. These results suggest that the reasons of readmission are not easily preventable. It is thought that the patients undergoing TJA can need a holistic approach to care, discharge education, home monitoring, and follow-up to reduce and prevent unplanned readmission.
Keywords: Arthroplasty; readmission; risk factors; pain; total hip arthroplasty; total knee arthroplasty
Amaç: Total eklem artroplastisi (TEA), konservatif tedavileri başarısız olan son dönem osteoartritli hastalar için önemli ölçüde ağrıyı dindiren ve fiziksel fonksiyonu artıran etkili bir cerrahi prosedürdür. TEA'nın klinik başarısına rağmen taburcu olduktan sonra hastanelere plansız yeniden başvurular yaygın, maliyeti artıran ve çoğu zaman önlenebilir bir durumdur. Bu çalışma, TEA sonrası yeniden hastaneye başvuru oranlarını, nedenlerini ve risk faktörlerini belirlemeyi amaçlamaktadır. Gereç ve Yöntemler: Bu tanımlayıcı retrospektif çalışmada, Ocak 2017-Temmuz 2018 tarihleri arasında bir kurumda total kalça ve diz artroplastisi uygulanan tüm hastaların elektronik tıbbi veri tabanındaki verileri analiz edilmiştir. Toplam 440 hasta dâhil edilmiştir. Taburculuk sonrası 1 yıl içinde yeniden hastaneye başvurunun (rutin kontrol dışı nedenlerle) risk faktörlerini belirlemek için 2 değişkenli lojistik regresyon analizi kullanılmıştır. Bulgular: TEA sonrası 1 yıl içinde yeniden hastaneye başvuru oranı %34,3'tür. Yeniden hastaneye başvurunun en yaygın nedenleri cerrahi işlemle ilgili ağrı, hareket kısıtlılığı ve cerrahi bölgede şişlik olarak bulunmuştur. Diğer başvuru nedenleri ise enfeksiyöz komplikasyonlara neden olan solunum problemleri, öksürük, balgam ve ateş olarak bulunmuştur. Ayrıca lojistik regresyon analizi, bazı komorbiditeleri (romatoid artrit, venöz yetersizlik, kronik obstrüktif akciğer hastalığı, aterosklerotik kalp hastalığı ve Alzheimer hastalığı) olan hastaların taburculuktan sonraki 1 yıl içinde yeniden hastaneye başvurma riskinin daha yüksek olduğunu göstermiştir. Sonuç: Yüksek yeniden başvuru oranları genellikle TEA ile ilişkili postoperatif sorunlardan kaynaklanmaktadır. Bu sonuçlar, yeniden başvuru nedenlerinin kolayca önlenebilir olmadığını göstermektedir. TEA geçiren hastaların plansız yeniden başvurularını azaltmak ve önlemek için bakım, taburculuk eğitimi, evde izleme ve takip için bütüncül bir yaklaşıma ihtiyaç duyabilecekleri düşünülmektedir.
Anahtar Kelimeler: Artroplasti; yeniden başvuru; risk faktörleri; ağrı; total kalça artroplastisi; total diz artroplastisi
- Ramkumar PN, Chu CT, Harris JD, Athiviraham A, Harrington MA, White DL, et al. Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop (Belle Mead NJ). 2015;44(9):397-405. [PubMed]
- Zmistowski B, Restrepo C, Hess J, Adibi D, Cangoz S, Parvizi J. Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. J Bone Joint Surg Am. 2013;95(20):1869-76. [Crossref] [PubMed]
- Saucedo JM, Marecek GS, Wanke TR, Lee J, Stulberg SD, Puri L. Understanding readmission after primary total hip and knee arthroplasty: who's at risk? J Arthroplasty. 2014;29(2):256-60. [Crossref] [PubMed]
- Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Hospital, patient, and clinical factors influence 30- and 90-day readmission after primary total hip arthroplasty. J Arthroplasty. 2016;31(10):2130-8. [Crossref] [PubMed]
- OECD. Hip and knee replacement. Health Care Activities Health at a Glance 2015: OECD Indicators. Paris, France: OECD Publishing; 2015. p.112-3. [Link]
- Iorio R, Robb WJ, Healy WL, Berry DJ, Hozack WJ, Kyle RF,et al. Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic. J Bone Joint Surg Am. 2008;90(7):1598-605. [Crossref] [PubMed]
- Pulido L, Parvizi J, Macgibeny M, Sharkey PF, Purtill JJ, Rothman RH, et al. In hospital complications after total joint arthroplasty. J Arthroplasty. 2008;23(6 Suppl 1):139-45. [Crossref] [PubMed]
- van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K,et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551-7. [Crossref] [PubMed] [PMC]
- Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-87. [Crossref] [PubMed] [PMC]
- Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345-9. Erratum in: CMAJ. 2004;170(5):771. [PubMed] [PMC]
- Soohoo NF, Farng E, Lieberman JR, Chambers L, Zingmond DS. Factors that predict short-term complication rates after total hip arthroplasty. Clin Orthop Relat Res. 2010;468(9):2363-71. [Crossref] [PubMed] [PMC]
- Phillips JLH, Rondon AJ, Vannello C, Fillingham YA, Austin MS, Courtney PM. How much does a readmission cost the bundle following primary hip and knee arthroplasty? J Arthroplasty. 2019;34(5):819-23. [Crossref] [PubMed]
- Urish KL, Qin Y, Li BY, Borza T, Sessine M, Kirk P, et al. Predictors and cost of readmission in total knee arthroplasty. J Arthroplasty. 2018;33(9):2759-63. [Crossref] [PubMed] [PMC]
- Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty? Clin Orthop Relat Res. 2017;475(12):2926-37. [Crossref] [PubMed] [PMC]
- Pugely AJ, Callaghan JJ, Martin CT, Cram P, Gao Y. Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. J Arthroplasty. 2013;28(9):1499-504. [Crossref] [PubMed]
- Avram V, Petruccelli D, Winemaker M, de Beer J. Total joint arthroplasty readmission rates and reasons for 30-day hospital readmission. J Arthroplasty. 2014;29(3):465-8. [Crossref] [PubMed]
- von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-7. Erratum in: Ann Intern Med. 2008;148(2):168. [Crossref] [PubMed]
- Pabinger C, Lothaller H, Geissler A. Utilization rates of knee-arthroplasty in OECD countries. Osteoarthritis Cartilage. 2015;23(10):1664-73. [Crossref] [PubMed]
- Husted H, Otte KS, Kristensen BB, Orsnes T, Kehlet H. Readmissions after fast-track hip and knee arthroplasty. Arch Orthop Trauma Surg. 2010;130(9):1185-91. [Crossref] [PubMed]
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