Thursday, October 24, 2013

Readmission after shoulder joint replacement

Readmission after shoulder arthroplasty

These authors conducted a retrospective view of all 680 shoulder arthroplasty procedures (124 hemiathroplasties, 376 total shoulders, and 180 reverse total shoulders) performed at their institution between 2005 and 2011.  The overall 90 day readmission rate was 5.9%, (8.8% for hemiarthroplasty, 4.5% for total shoulder and 6.6% for reverse total shoulder arthroplasty). Most readmissions after hemiarthroplasty and reverse total shoulder occurred within 30 days of discharge. 

Of note is that the number of hemiarthroplasty procedures performed decreased from 28 cases in 2005 to 8 in 2011. Conversely reverse total shoulder procedures increased from 4 cases in 2005 to 62 cases in 2011. The rate of readmission after reverse total shoulders decreased from 1 of 4 in 2005 (25%) to 4 of 62 in 2011 (5.5%). 

Reasons for readmission after hemiarthroplasty included fall, infection, instability, cuff tear, and arthritic pain.
Reasons for readmission after total shoulder were deep infection rotator cuff tear, pulmonary infections, pain, cardiac issues, urinary tract infection, and fracture.
Reasons for readmission after reverse total shoulder were for instability, small bowel obstruction, deep infection, cellulitis, fracture, and instability.

It was evident from the manuscript that patients requiring readmission often had more complex pathology prior to their index arthroplasty. For example, 5 of the 11 hemiarthroplasties requiring revision were for fracture and 2 were for arthritis associated with instability. 

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