Improving Orthopedic Patient Outcomes: A Model to Predict 30-Day and 90-Day Readmission Rates Following Total Joint Arthroplasty.

BACKGROUND: Over the next 10-15 years, there is expected to be an exponential increase in the number of total joint arthroplasties in the American population. This, combined with rising costs of total joint arthroplasty and more recent changes to the reimbursement payment models, increases the demand to perform quality, cost-effective total joint arthroplasties. The purpose of this study is to build models that could be used to estimate the 30-day and 90-day readmission rates for patients undergoing total joint arthroplasty. METHODS: A retrospective review of patients admitted to a single hospital, over the course of 56 months, for total joint arthroplasty was performed. The goal is to identify patients with readmission in a 30-day or 90-day period following discharge from the hospital. Binary logistic regression was used to build predictive models that estimate the likelihood of readmission based on a patient's risk factors. RESULTS: Of 5732 patients identified for this study, 237 were readmitted within 30 days, while 547 were readmitted within 90 days. Age, body mass index, gender, discharge disposition, occurrence of cardiac dysrhythmias and heart failure, emergency department visits, psychiatric diagnoses, and medication counts were all found to be associated with 30-day admission rates. Similar associations were found at 90 days, with the exclusion of age and psychiatric drug use, and the inclusion of intravenous drug abuse, narcotic medications, and total joint arthroplasty within 12 months. CONCLUSION: There are patient variables, or risk factors, that serve to predict the likelihood of readmission following total joint arthroplasty.

Intermediate and long-term follow-up of total shoulder arthroplasty for the management of postcapsulorrhaphy arthropathy.

BACKGROUND: The purpose of this study was to evaluate the subjective and objective outcomes in patients undergoing total shoulder arthroplasty for treatment of postcapsulorrhaphy arthropathy (CA) and compare them with outcomes in patients undergoing total shoulder arthroplasty for primary glenohumeral osteoarthritis (OA). METHODS: Total shoulder arthroplasty was used to treat 25 consecutive CA patients (25 shoulders) at our institution; of these, 22 patients were available for follow-up. An age-matched cohort of 19 consecutive patients (20 shoulders) who were treated with total shoulder arthroplasty for primary glenohumeral OA was compared with the CA group. Patients were evaluated by physical examination and patient outcome measures (American Shoulder and Elbow Surgeons assessment and Simple Shoulder Test). Complications, reoperations, and subscapularis function was also recorded. RESULTS: Compared with the CA group, the OA group achieved greater forward elevation (165° vs 147°; P = .036) and greater external rotation (56° vs. 45°; P = .04); however, no significant differences were seen in subjective patient scores between the 2 groups for Simple Shoulder Test (P = .90), American Shoulder and Elbow Surgeons assessment (P = .65), and pain scores (P = .80). The difference in the number of revision surgeries in the OA group compared with the CA group (1 vs 4) was not significant (P = .35). A significantly higher number of patients in the CA group had subscapularis insufficiency compared with the OA group (5 CA vs 0 OA; P = .049). CONCLUSIONS: Our findings suggest that when compared with patients undergoing total shoulder arthroplasty for primary OA, CA patients experience similar outcomes with respect to revision surgery, pain relief, and subjective self-assessment and have a higher incidence of subscapularis insufficiency.