Sunday, August 31, 2014

Risk factors for hospital readmission after shoulder arthroplasty - consequences

Hospital readmissions after primary shoulder arthroplasty.

These authors used State Inpatient Databases from 7 different states  to identify 26,218 patients who underwent hemiarthroplasty, total shoulder arthroplasty, or reverse total shoulder arthroplasty from 2005 through 2010.

These patients had an overall 90-day readmission rate of 7.3%. RTSA had the highest rate (11.2%), followed by hemiarthroplasty (8.2%) and TSA (6.0%; P < .001). Medical complications contributed to 82% of readmissions, and surgical complications contributed to 18%. Osteoarthritis was the most common medical diagnosis (11%), followed by deep venous thrombosis or pulmonary embolism (4.4%) and pneumonia (3.9%). Infection was the most common surgical cause of readmission (4.8%), followed by dislocation (4.6%). There was a stepwise increase in risk of readmission with increasing age as well as for patients with comorbidities. Patients with Medicaid insurance had more than a 50% greater risk of readmission than patients with Medicare. Procedures performed at medium-volume and high-volume hospitals showed lower risk of readmission than low-volume centers.
Comment: The importance of developing strategies for minimizing readmissions has recently be amplified by the Centers for Medicare and Medicaid Services' Readmission Reduction Program that requires CMS to reduce payments to hospitals with excess readmissions, a program that became effective for discharges beginning on October 1, 2012. It is of note that such a program can create an unintended consequence:  a disincentive to offer shoulder arthroplasty to older individuals on Medicaid insurance who have comorbidities. If such patients are to receive surgical care for shoulder arthritis, steps will be needed to modulate the risk to medical centers.


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