Cargando…

Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients

PURPOSE: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improv...

Descripción completa

Detalles Bibliográficos
Autores principales: Malpani, Rohil, John, Tamara S., Mercier, Michael R., Ottesen, Taylor D., Nduaguba, Afamefuna M., Webb, Matthew L., Grauer, Jonathan N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384800/
https://www.ncbi.nlm.nih.gov/pubmed/33969951
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00110
_version_ 1783563668757151744
author Malpani, Rohil
John, Tamara S.
Mercier, Michael R.
Ottesen, Taylor D.
Nduaguba, Afamefuna M.
Webb, Matthew L.
Grauer, Jonathan N.
author_facet Malpani, Rohil
John, Tamara S.
Mercier, Michael R.
Ottesen, Taylor D.
Nduaguba, Afamefuna M.
Webb, Matthew L.
Grauer, Jonathan N.
author_sort Malpani, Rohil
collection PubMed
description PURPOSE: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improvement Program database. METHODS: Adult patients who underwent DRF ORIF were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Patient demographics, comorbidity status, hospital metrics, and 30-day perioperative outcomes were tabulated. Readmission, time to readmission, and reason for readmission were assessed. Reasons for readmission were categorized. Risk factors for readmission were assessed with multivariate analyses. RESULTS: Of 11,124 patients who underwent DRF ORIF, 196 (1.76%) were readmitted within 30 days. Based on multivariate analysis, predictors of readmission (P < 0.05) were as follows: American Society of Anesthesiologist class > 3 (Odds ratio [OR] = 2.87), functionally dependent status (OR = 2.25), diabetes with insulin use (OR = 1.97), and staying in hospital after the index surgery (inpatient procedure, OR = 2.04). Readmissions occurred at approximately 14 days postoperatively. Of the recorded reasons for readmission after DRF ORIF, approximately one quarter were for surgical reasons, whereas over 75% of readmissions were for medical reasons unrelated to the surgery. CONCLUSION: This study found the rate of 30-day unplanned readmissions after DRF ORIF to be 1.76%. Demographic, comorbid, and perioperative factors predictive of readmission were defined. Most postoperative readmissions were for medical reasons unrelated to the surgical site and occurred at an average of approximately 2 weeks postoperatively. Multivariate analysis found that patients with increased American Society of Anesthesiologist class > 3, functional dependence, insulin-dependent diabetes, and those who underwent inpatient surgery for any reason were at a greater risk for readmission. Understanding these factors may aid in patient counseling and quality improvement initiatives, and this information should be used for risk stratification and risk adjustment of quality measures.
format Online
Article
Text
id pubmed-7384800
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer
record_format MEDLINE/PubMed
spelling pubmed-73848002020-08-05 Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients Malpani, Rohil John, Tamara S. Mercier, Michael R. Ottesen, Taylor D. Nduaguba, Afamefuna M. Webb, Matthew L. Grauer, Jonathan N. J Am Acad Orthop Surg Glob Res Rev Research Article PURPOSE: Distal radius fracture (DRF) open reduction and internal fixation (ORIF) is a common surgical procedure. This study assesses reasons and risk factors for readmission after DRF ORIF using the large sample size and follow-up of the American College of Surgeons National Surgical Quality Improvement Program database. METHODS: Adult patients who underwent DRF ORIF were identified in the 2011 to 2016 National Surgical Quality Improvement Program database. Patient demographics, comorbidity status, hospital metrics, and 30-day perioperative outcomes were tabulated. Readmission, time to readmission, and reason for readmission were assessed. Reasons for readmission were categorized. Risk factors for readmission were assessed with multivariate analyses. RESULTS: Of 11,124 patients who underwent DRF ORIF, 196 (1.76%) were readmitted within 30 days. Based on multivariate analysis, predictors of readmission (P < 0.05) were as follows: American Society of Anesthesiologist class > 3 (Odds ratio [OR] = 2.87), functionally dependent status (OR = 2.25), diabetes with insulin use (OR = 1.97), and staying in hospital after the index surgery (inpatient procedure, OR = 2.04). Readmissions occurred at approximately 14 days postoperatively. Of the recorded reasons for readmission after DRF ORIF, approximately one quarter were for surgical reasons, whereas over 75% of readmissions were for medical reasons unrelated to the surgery. CONCLUSION: This study found the rate of 30-day unplanned readmissions after DRF ORIF to be 1.76%. Demographic, comorbid, and perioperative factors predictive of readmission were defined. Most postoperative readmissions were for medical reasons unrelated to the surgical site and occurred at an average of approximately 2 weeks postoperatively. Multivariate analysis found that patients with increased American Society of Anesthesiologist class > 3, functional dependence, insulin-dependent diabetes, and those who underwent inpatient surgery for any reason were at a greater risk for readmission. Understanding these factors may aid in patient counseling and quality improvement initiatives, and this information should be used for risk stratification and risk adjustment of quality measures. Wolters Kluwer 2020-07-20 /pmc/articles/PMC7384800/ /pubmed/33969951 http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00110 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Malpani, Rohil
John, Tamara S.
Mercier, Michael R.
Ottesen, Taylor D.
Nduaguba, Afamefuna M.
Webb, Matthew L.
Grauer, Jonathan N.
Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title_full Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title_fullStr Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title_full_unstemmed Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title_short Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
title_sort readmissions after distal radius fracture open reduction and internal fixation: an analysis of 11,124 patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384800/
https://www.ncbi.nlm.nih.gov/pubmed/33969951
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00110
work_keys_str_mv AT malpanirohil readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT johntamaras readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT merciermichaelr readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT ottesentaylord readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT nduagubaafamefunam readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT webbmatthewl readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients
AT grauerjonathann readmissionsafterdistalradiusfractureopenreductionandinternalfixationananalysisof11124patients