Citation

Avinash M, Rajasekaran S, Aiyer SN. J. Orthop. 2017; 14(2): 236-240.

Affiliation

Department of Orthopaedic Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.

Copyright

(Copyright © 2017, P. K. Surendran Memorial Education Foundation, Publisher Elsevier Publishing)

DOI

10.1016/j.jor.2017.03.001

PMID

28331279

PMCID

PMC5348599

Abstract

INTRODUCTION: Unplanned readmissions are an undesirable and expensive outcome of clinical practice. Previous reported literature is limited by retrospective study designs and 30 day study intervals. We analyzed causes for 90-day unplanned readmission, temporal occurrence of major causes, possible predisposing factors, bed days lost and economic impact. MATERIALS & METHODS: A prospective analysis of 12729 admissions was performed over 1 year in an Orthopaedic unit. Consecutive readmissions for unplanned circumstances within 90-days of discharge following the index procedure were included. Open injuries, polytrauma, primary osseous infections and planned readmissions were excluded.

RESULTS: We noted an overall readmission rate of 2.07% and subspecialty rate of 1.43%, 3.32%, 2.9% in trauma, spine and total joint arthroplasty (TJA) respectively. The leading cause was wound complications accounting for 49.62%, followed by medical causes (trauma -18.37%; TJA -27.5%) and aseptic pain (spine-31.6%). Though 87.1% of superficial surgical site infections (SSIs) occurred within 30 days, 21.1%, 41.2% and 60% of the deep SSIs in spine, trauma and TJA respectively occurred beyond 30 days. The financial burden amounted to INR 1,01,55,770 and mean bed days lost was 7.6 per readmission. Age ≥70 years, indoor-stay ≥10 days, health insurance and co-morbid illnesses were associated with readmissions (p < 0.05).

CONCLUSIONS: Our study showed that limiting analysis to 30 day unplanned readmissions would lead to failure in identification of 34.85% of readmissions especially deep surgical site infections in TJA and trauma.

Language: en

Keywords

Complications; Quality of health care; Readmissions; Surgical site infections; Total joint arthroplasty; Trauma