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Thirty-day readmission rates in orthopedics: a systematic review and meta-analysis.

Bernatz JT, Tueting JL, Anderson PA - PLoS ONE (2015)

Bottom Line: A survey of the present rates is needed before policies can be developed to decrease incidence of readmission.There was no significant difference between subspecialties.The 30-day readmission rate has decreased in the past ten years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Rehabilitative Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.

ABSTRACT

Background: Hospital readmission rates are being used to evaluate performance. A survey of the present rates is needed before policies can be developed to decrease incidence of readmission. We address three questions: What is the present rate of 30-day readmission in orthopedics? How do factors such as orthopedic specialty, data source, patient insurance, and time of data collection affect the 30-day readmission rate? What are the causes and risk factors for 30-day readmissions?

Methods/findings: A review was first registered with Prospero (CRD42014010293, 6/17/2014) and a meta-analysis was performed to assess the current 30-day readmission rate in orthopedics. Studies published after 2006 were retrieved, and 24 studies met the inclusion criteria. The 30-day readmission rate was extrapolated from each study along with the orthopedic subspecialty, data source, patient insurance, time of collection, patient demographics, and cause of readmission. A sensitivity analysis was completed on the stratified groups. The overall 30-day readmission rate across all orthopedics was 5.4 percent (95% confidence interval: 4.8,6.0). There was no significant difference between subspecialties. Studies that retrieved data from a multicenter registry had a lower 30-day readmission rate than those reporting data from a single hospital or a large national database. Patient populations that only included Medicare patients had a higher 30-day readmission rate than populations of all insurance. The 30-day readmission rate has decreased in the past ten years. Age, length of stay, discharge to skilled nursing facility, increased BMI, ASA score greater than 3, and Medicare/Medicaid insurance showed statistically positive correlation with increased 30-day readmissions in greater than 75 percent of studies. Surgical site complications accounted for 46 percent of 30-day readmissions.

Conclusions: This meta-analysis shows the present rate of 30-day readmissions in orthopedics. Demonstrable heterogeneity between studies underlines the importance of uniform collection and reporting of readmission rates for hospital evaluation and reimbursement.

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Flowchart of systematic review methodology.
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pone.0123593.g001: Flowchart of systematic review methodology.

Mentions: The study was registered with Prospero, an international database of prospectively registered systematic reviews (CRD42014010293, 6/17/2014). Two independent reviewers then conducted a systematic literature search of four electronic databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) for articles published in English after 2006 (Fig 1). Searches were performed using Medical Subject Headings (MeSH) used by the National Library of Medicine. The MeSH terms were used to produce the search: “(patient readmission OR readmission*) AND (30 day* OR thirty day) AND (orthopedic* OR orthopaedic* OR spine).” This search yielded 83 articles from PubMed. Four additional, non-duplicate studies were found using the same search criteria in the Web of Science and the Cochrane Library. Google Scholar did not yield any additional studies. These 87 articles underwent title/abstract review and 38 met the primary exclusion criteria. Studies were eliminated if: the study tested a specific medical device, surgical technique, or post-operative care protocol (18 studies), the patients were already subgrouped (i.e. diabetic patients with hip fracture) (9), the majority were outpatient procedures (3), there were fewer than 100 patients (3), the study did not report on orthopedic procedures/admissions (3), or if the data collection began before the year 2000 (2) (S1 Table). This left 49 studies for full-text review. The inclusion criteria were studies that quantified 30-day readmission rates following any orthopedic procedure or admission; twenty-five did not report an all-cause 30-day readmission rate. This left 24 publications included in this study. There were no restrictions on the study design (retrospective, prospective, cohort, case-control, etc.). Studies that included inpatient-only procedures or both inpatient and outpatient procedures were considered.


Thirty-day readmission rates in orthopedics: a systematic review and meta-analysis.

Bernatz JT, Tueting JL, Anderson PA - PLoS ONE (2015)

Flowchart of systematic review methodology.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401733&req=5

pone.0123593.g001: Flowchart of systematic review methodology.
Mentions: The study was registered with Prospero, an international database of prospectively registered systematic reviews (CRD42014010293, 6/17/2014). Two independent reviewers then conducted a systematic literature search of four electronic databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) for articles published in English after 2006 (Fig 1). Searches were performed using Medical Subject Headings (MeSH) used by the National Library of Medicine. The MeSH terms were used to produce the search: “(patient readmission OR readmission*) AND (30 day* OR thirty day) AND (orthopedic* OR orthopaedic* OR spine).” This search yielded 83 articles from PubMed. Four additional, non-duplicate studies were found using the same search criteria in the Web of Science and the Cochrane Library. Google Scholar did not yield any additional studies. These 87 articles underwent title/abstract review and 38 met the primary exclusion criteria. Studies were eliminated if: the study tested a specific medical device, surgical technique, or post-operative care protocol (18 studies), the patients were already subgrouped (i.e. diabetic patients with hip fracture) (9), the majority were outpatient procedures (3), there were fewer than 100 patients (3), the study did not report on orthopedic procedures/admissions (3), or if the data collection began before the year 2000 (2) (S1 Table). This left 49 studies for full-text review. The inclusion criteria were studies that quantified 30-day readmission rates following any orthopedic procedure or admission; twenty-five did not report an all-cause 30-day readmission rate. This left 24 publications included in this study. There were no restrictions on the study design (retrospective, prospective, cohort, case-control, etc.). Studies that included inpatient-only procedures or both inpatient and outpatient procedures were considered.

Bottom Line: A survey of the present rates is needed before policies can be developed to decrease incidence of readmission.There was no significant difference between subspecialties.The 30-day readmission rate has decreased in the past ten years.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Rehabilitative Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.

ABSTRACT

Background: Hospital readmission rates are being used to evaluate performance. A survey of the present rates is needed before policies can be developed to decrease incidence of readmission. We address three questions: What is the present rate of 30-day readmission in orthopedics? How do factors such as orthopedic specialty, data source, patient insurance, and time of data collection affect the 30-day readmission rate? What are the causes and risk factors for 30-day readmissions?

Methods/findings: A review was first registered with Prospero (CRD42014010293, 6/17/2014) and a meta-analysis was performed to assess the current 30-day readmission rate in orthopedics. Studies published after 2006 were retrieved, and 24 studies met the inclusion criteria. The 30-day readmission rate was extrapolated from each study along with the orthopedic subspecialty, data source, patient insurance, time of collection, patient demographics, and cause of readmission. A sensitivity analysis was completed on the stratified groups. The overall 30-day readmission rate across all orthopedics was 5.4 percent (95% confidence interval: 4.8,6.0). There was no significant difference between subspecialties. Studies that retrieved data from a multicenter registry had a lower 30-day readmission rate than those reporting data from a single hospital or a large national database. Patient populations that only included Medicare patients had a higher 30-day readmission rate than populations of all insurance. The 30-day readmission rate has decreased in the past ten years. Age, length of stay, discharge to skilled nursing facility, increased BMI, ASA score greater than 3, and Medicare/Medicaid insurance showed statistically positive correlation with increased 30-day readmissions in greater than 75 percent of studies. Surgical site complications accounted for 46 percent of 30-day readmissions.

Conclusions: This meta-analysis shows the present rate of 30-day readmissions in orthopedics. Demonstrable heterogeneity between studies underlines the importance of uniform collection and reporting of readmission rates for hospital evaluation and reimbursement.

Show MeSH