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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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Regression plot of 30-day readmission rate versus time when patient enrollment began.Regression line: y = 0.004x – 3.3. P-value = 0.00292. Logit event rate = natural log of 30-day readmission rate.
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pone.0123593.g007: Regression plot of 30-day readmission rate versus time when patient enrollment began.Regression line: y = 0.004x – 3.3. P-value = 0.00292. Logit event rate = natural log of 30-day readmission rate.

Mentions: The most recent studies, which began collecting data after 2009, had a 30-day readmission rate of 4.5% (Table 6). This is significantly lower than the 30-day readmission rate of 7.7% in studies that began data collection between 2006–2009 and the 7.8% readmission rate demonstrated in studies that began data collection before 2006 (p-value = 0.030). When plotted as the natural log of 30-day readmission rate versus time since enrollment began, the meta-regression was statistically significant with p-value of 0.0029 (Fig 7).


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

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

Regression plot of 30-day readmission rate versus time when patient enrollment began.Regression line: y = 0.004x – 3.3. P-value = 0.00292. 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.g007: Regression plot of 30-day readmission rate versus time when patient enrollment began.Regression line: y = 0.004x – 3.3. P-value = 0.00292. Logit event rate = natural log of 30-day readmission rate.
Mentions: The most recent studies, which began collecting data after 2009, had a 30-day readmission rate of 4.5% (Table 6). This is significantly lower than the 30-day readmission rate of 7.7% in studies that began data collection between 2006–2009 and the 7.8% readmission rate demonstrated in studies that began data collection before 2006 (p-value = 0.030). When plotted as the natural log of 30-day readmission rate versus time since enrollment began, the meta-regression was statistically significant with p-value of 0.0029 (Fig 7).

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
Related in: MedlinePlus