Dataset Information

The Impact of Hospital Volume on Racial Differences in Complications, Readmissions, and Emergency Department Visits Following Total Joint Arthroplasty.

ABSTRACT: BACKGROUND:Minority patients are at higher risk for complications and readmissions after total hip and knee arthroplasty. They are also more likely to undergo joint replacement in lower volume centers, which is associated with poorer outcomes. It is unknown whether these disparities simply reflect disproportionate use of lower volume centers. This study evaluates the impact of hospital volume on racial differences in outcomes following joint replacement. METHODS:Patients who underwent total hip or knee arthroplasty between 2006 and 2013 in New York and Florida were identified through the Healthcare Cost and Utilization Project State Inpatient Databases. Complications, readmissions, and emergency department (ED) visits within 90 days were compared by hospital volume. Relative risks were calculated with generalized estimating equations for risk factors associated with adverse outcomes. RESULTS:Race/ethnicity was not associated with readmission following hip replacement. Black race was associated with readmission following knee replacement (relative risk [RR] 1.16). Black race was associated with ED visits following hip replacement (RR 1.29) and knee replacement (RR 1.33). Hispanic ethnicity was associated with ED visits following knee replacement (RR 1.15), but not hip replacement. These associations did not change after adjusting for hospital volume. CONCLUSION:Adjusting for hospital volume does not alter the risk of readmissions and ED use associated with minority race/ethnicity, suggesting that hospital volume alone may be insufficient to explain racial differences in outcome.

SUBMITTER: Adelani MA

PROVIDER: S-EPMC5992889 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The Impact of Hospital Volume on Racial Differences in Complications, Readmissions, and Emergency Department Visits Following Total Joint Arthroplasty.

Adelani Muyibat A MA Keller Matthew R MR Barrack Robert L RL Olsen Margaret A MA

The Journal of arthroplasty 20170925 2

<h4>Background</h4>Minority patients are at higher risk for complications and readmissions after total hip and knee arthroplasty. They are also more likely to undergo joint replacement in lower volume centers, which is associated with poorer outcomes. It is unknown whether these disparities simply reflect disproportionate use of lower volume centers. This study evaluates the impact of hospital volume on racial differences in outcomes following joint replacement.<h4>Methods</h4>Patients who under ...[more]

PMID: 29066108

Similar Datasets

Project description:Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

Project description:BackgroundUnplanned visits to the emergency department after total joint arthroplasty are far more common than unplanned readmissions. Our objectives were to characterize the prevalence of presentation to an emergency department for any reason after total joint arthroplasty and to identify risk factors for such visits.MethodsUsing health administrative databases, we conducted a population-based retrospective cohort study of adults (19-89 yr of age) who received their first primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) procedure for arthritis between April 2011 and March 2016 in Ontario. We made univariate comparisons between patients who presented to the emergency department within 30 days of surgery and those who did not in. We determined differences in use of health care services between groups by comparing the change in use in the year before and after surgery between patients who presented to the emergency department and those who did not. We developed logistic regression models for the occurrence of an emergency department visit using backward variable elimination.ResultsWe identified 42 273 total hip recipients and 70 725 total knee recipients, of whom 5640 (13.3%) and 11 224 (15.9%), respectively, presented to the emergency department within 30 days of surgery. Fewer than 1% of these patients required admission, and nearly half (45%) went to a different institution from where they had their surgery. Among both THA and TKA recipients, patients who presented to the emergency department had a net increase in their median annual health care costs (THA: $501, TKA: $682), compared to a net decrease for the cohort as a whole. Factors associated with increased risk of an emergency visit included increased patient age, male sex, rural residence and various comorbidities. Predictive regression models showed poor discriminative ability for both THA (C-statistic 0.57) and TKA (C-statistic 0.58) recipients.InterpretationOne in 7 patients presented to the emergency department within 30 days of THA or TKA. Some may conceivably have been managed remotely, and very few required readmission. There is a crucial need for strategies to minimize these events.

Project description:BackgroundTotal ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration.MethodsThis retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits.ResultsOf 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) (P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem.ConclusionOf 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs.Level of evidenceLevel III, retrospective cohort study.

Dataset Information

The Impact of Hospital Volume on Racial Differences in Complications, Readmissions, and Emergency Department Visits Following Total Joint Arthroplasty.

Publications

The Impact of Hospital Volume on Racial Differences in Complications, Readmissions, and Emergency Department Visits Following Total Joint Arthroplasty.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets