Limits...
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.

Show MeSH
Funnel plot assessing publication bias.Missing studies to the right of average and near the bottom indicate that the literature lacks studies with higher readmission rates and fewer patients, respectively. Logit event rate = natural log of 30-day readmission rate.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4401733&req=5

pone.0123593.g003: Funnel plot assessing publication bias.Missing studies to the right of average and near the bottom indicate that the literature lacks studies with higher readmission rates and fewer patients, respectively. Logit event rate = natural log of 30-day readmission rate.

Mentions: The 30-day readmission rate across all orthopedic specialties was 5.4% (Confidence interval: 4.8,6.1) (Fig 2). The studies had high heterogeneity with an I-squared value of 98.2%. The funnel plot for publication bias shows that there are studies missing to the right of average, meaning that there is a lack of studies with a higher readmission rate (Fig 3). There are also few studies near the bottom of the funnel, suggesting the literature is missing studies with fewer patients. Studies testing for publication bias including Orwin’s fail safe and the trim and fill did not indicate that missing studies would have changed the results significantly. Sensitivity analysis did not change any outcomes significantly.


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

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

Funnel plot assessing publication bias.Missing studies to the right of average and near the bottom indicate that the literature lacks studies with higher readmission rates and fewer patients, respectively. Logit event rate = natural log of 30-day readmission rate.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0123593.g003: Funnel plot assessing publication bias.Missing studies to the right of average and near the bottom indicate that the literature lacks studies with higher readmission rates and fewer patients, respectively. Logit event rate = natural log of 30-day readmission rate.
Mentions: The 30-day readmission rate across all orthopedic specialties was 5.4% (Confidence interval: 4.8,6.1) (Fig 2). The studies had high heterogeneity with an I-squared value of 98.2%. The funnel plot for publication bias shows that there are studies missing to the right of average, meaning that there is a lack of studies with a higher readmission rate (Fig 3). There are also few studies near the bottom of the funnel, suggesting the literature is missing studies with fewer patients. Studies testing for publication bias including Orwin’s fail safe and the trim and fill did not indicate that missing studies would have changed the results significantly. Sensitivity analysis did not change any outcomes significantly.

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