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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery</title><author><name sortKey="Martin, Christopher T" sort="Martin, Christopher T" uniqKey="Martin C" first="Christopher T" last="Martin">Christopher T. Martin</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author><author><name sortKey="Gao, Yubo" sort="Gao, Yubo" uniqKey="Gao Y" first="Yubo" last="Gao">Yubo Gao</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author><author><name sortKey="Pugely, Andrew J" sort="Pugely, Andrew J" uniqKey="Pugely A" first="Andrew J." last="Pugely">Andrew J. Pugely</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27528853</idno><idno type="pmc">4910810</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4910810</idno><idno type="RBID">PMC:4910810</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002E72</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002E72</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery</title><author><name sortKey="Martin, Christopher T" sort="Martin, Christopher T" uniqKey="Martin C" first="Christopher T" last="Martin">Christopher T. Martin</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author><author><name sortKey="Gao, Yubo" sort="Gao, Yubo" uniqKey="Gao Y" first="Yubo" last="Gao">Yubo Gao</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author><author><name sortKey="Pugely, Andrew J" sort="Pugely, Andrew J" uniqKey="Pugely A" first="Andrew J." last="Pugely">Andrew J. Pugely</name><affiliation><nlm:aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</nlm:aff></affiliation></author></analytic><series><title level="j">The Iowa Orthopaedic Journal</title><idno type="ISSN">1541-5457</idno><idno type="eISSN">1555-1377</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery.</p></sec><sec><title>Methods</title><p>Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission.</p></sec><sec><title>Results</title><p>There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each).</p></sec><sec><title>Conclusions</title><p>The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and should focus on wound complications and fall risks in order to minimize readmissions. Further, quality-reporting metrics should account for the risk factors identified here, in order to prevent penalties against surgeons who take on complex patients.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Iowa Orthop J</journal-id><journal-id journal-id-type="iso-abbrev">Iowa Orthop J</journal-id><journal-id journal-id-type="publisher-id">ioj</journal-id><journal-id journal-id-type="pmc">ioj</journal-id><journal-title-group><journal-title>The Iowa Orthopaedic Journal</journal-title></journal-title-group><issn pub-type="ppub">1541-5457</issn><issn pub-type="epub">1555-1377</issn><publisher><publisher-name>The University of Iowa</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27528853</article-id><article-id pub-id-type="pmc">4910810</article-id><article-categories><subj-group subj-group-type="heading"><subject>Special Interest</subject></subj-group></article-categories><title-group><article-title>Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Martin</surname><given-names>Christopher T</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gao</surname><given-names>Yubo</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pugely</surname><given-names>Andrew J.</given-names></name><degrees>MD</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib></contrib-group><aff id="au1">The Department of Orthopedic Surgery and Rehabilitation University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242</aff><author-notes><corresp id="cor1">Christopher T. Martin, MD Department of Orthopedic Surgery University of Iowa Hospitals and Clinics 200 Hawkins Drive, 01008 JPP Iowa City, IA 52242 Email: <email>Christopher-T-Martin@uiowa.edu</email></corresp><fn><p>Conflict of Interest Statement: Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.</p></fn><fn><p>Ethical Review Committee Statement: This study received an exemption by the institutional review board at the University of Iowa.</p></fn><fn><p>Disclaimer: The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.</p></fn></author-notes><pub-date pub-type="ppub"><year>2016</year></pub-date><volume>36</volume><fpage>155</fpage><lpage>160</lpage><permissions><copyright-statement>Copyright © The Iowa Orthopaedic Journal 2016</copyright-statement><copyright-year>2016</copyright-year></permissions><abstract><sec><title>Background</title><p>Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery.</p></sec><sec><title>Methods</title><p>Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission.</p></sec><sec><title>Results</title><p>There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each).</p></sec><sec><title>Conclusions</title><p>The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and should focus on wound complications and fall risks in order to minimize readmissions. Further, quality-reporting metrics should account for the risk factors identified here, in order to prevent penalties against surgeons who take on complex patients.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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