Risk Factors for 30-Day Readmission Following Hip Arthroscopy

Transcription

1 Risk Factors for 30-Day Readmission Following Hip Arthroscopy Matthew Hartwell, MD Allison Morgan, BA Daniel Johnson, MD Richard Nicolay, MD Ryan Selley, MD Michael Terry, MD Vehniah Tjong, MD

2 Disclosures Matthew Hartwell, MD Allison Morgan, BA Daniel Johnson, MD Richard Nicolay, MD Ryan Selley, MD Robert Christian, MD Michael Terry, MD - Paid consultant for Arthrex, Smith & Nephew Vehniah Tjong, MD - Paid consultant for Smith & Nephew

3 Introduction The utilization of hip arthroscopy has increased dramatically over the past decade. Clinical outcomes following hip arthroscopy have been excellent with high rates of patient satisfaction and postoperative function. Hip arthroscopy is known to be relatively safe with low reported major postoperative complication and 30-day readmission rates. Given the increasing surgical volume of hip arthroscopy, there is a need to identify risk factors for readmission to guide providers in terms of preoperative evaluation, patient counseling, and improve overall patient outcomes.

4 Aim The purpose of this study is to evaluate hip arthroscopy cases in a national surgical database to identify risk factors associated with readmission following this routine outpatient orthopaedic procedure.

5 Methods The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried from 2012 to 2016 for current procedural terminology (CPT) billing codes related to hip arthroscopy. International Classification of Diseases, Ninth and Tenth Editions (ICD-9 and ICD-10) diagnostic codes were then used to exclude cases which involved infection, fracture, or an open procedure. Patients were subsequently reviewed for readmission within 30 days. Univariate and multivariate analyses were then performed to identify risk factors associated with 30-day readmission.

6 Results Table 1

7 Results Table 2

8 Results Table 3

9 Results The most common CPTs were labral resection or chondroplasty (n=589, 39.5%) and femoroplasty (n=527, 35.3%). The overall 30-day complication rate was 1.67% and the most common complications following the procedure were bleeding, (n=12, 0.80%), superficial infections (n=5, 0.33%), and returning to the operating room (n=4, 0.27%). The 30-day readmission rate was 1.34%. On multivariate analysis, the following variables were identified as independent risk factors for readmission: hypertension requiring medication (OR, 3.45; 95% CI, ) chronic corticosteroid or immunosuppressant use for a chronic condition within 30 days prior to the procedure (OR, 7.16; 95% CI, ). There was no difference in complication rates when hip arthroscopy was performed with isolated femoroplasty (n=340), isolated acetabuloplasty (n=103), both (n=187) or neither (n=863).

10 Conclusions These findings confirm that the 30-day readmission (1.34%) and complication rate (1.67%) is low for isolated hip arthroscopy procedures, however hypertension and chronic steroid use are independent risk factors for readmission.

11 References 1. Cvetanovich GL, Chalmers PN, Levy DM, et al. Hip Arthroscopy Surgical Volume Trends and 30-Day Postoperative Complications. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2016;32(7): Bozic KJ, Chan V, Valone FH, 3rd, Feeley BT, Vail TP. Trends in hip arthroscopy utilization in the United States. The Journal of arthroplasty. 2013;28(8 Suppl): Bonazza NA, Homcha B, Liu G, Leslie DL, Dhawan A. Surgical Trends in Arthroscopic Hip Surgery Using a Large National Database. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Colvin AC, Harrast J, Harner C. Trends in hip arthroscopy. J Bone Joint Surg Am. 2012;94(4):e Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2013;29(4): Degen RM, Bernard JA, Pan TJ, et al. Hip arthroscopy utilization and associated complications: a population-based analysis. Journal of hip preservation surgery. 2017;4(3): Harris JD, McCormick FM, Abrams GD, et al. Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2013;29(3): Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA. Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up. J Bone Joint Surg Br. 2009;91(1): Byrd JW, Jones KS. Hip arthroscopy for labral pathology: prospective analysis with 10-year follow-up. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2009;25(4): Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2008;24(5): Philippon M, Schenker M, Briggs K, Kuppersmith D. Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression. Knee Surg Sports Traumatol Arthrosc. 2007;15(7): Botser IB, Smith TW, Jr., Nasser R, Domb BG. Open surgical dislocation versus arthroscopy for femoroacetabular impingement: a comparison of clinical outcomes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2011;27(2): Malviya A, Raza A, Jameson S, James P, Reed MR, Partington PF. Complications and survival analyses of hip arthroscopies performed in the national health service in England: a review of 6,395 cases. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2015;31(5): Zimmerer A, Sobau C, Ries C, Miehlke W. Femoral neck fracture is a rare complication after arthroscopic femoroplasty for femoroacetabular impingement with no known prognostic factors and few reported risk factors: a systematic review Wang AS, Armstrong EJ, Armstrong AW. Corticosteroids and wound healing: clinical considerations in the perioperative period. Am J Surg. 2013;206(3): Ismael H, Horst M, Farooq M, Jordon J, Patton JH, Rubinfeld IS. Adverse effects of preoperative steroid use on surgical outcomes. Am J Surg. 2011;201(3): ; discussion Aronow WS. Management of hypertension in patients undergoing surgery. In: Ann Transl Med. Vol Varon J, Marik PE. Perioperative hypertension management. Vasc Health Risk Manag. 2008;4(3):