Defining readmissions among patients undergoing open reduction and internal fixation (ORIF) in claims database analyses.

Objective: To evaluate the impact of using different readmissions definitions among patients undergoing open reduction and internal fixation (ORIF) of the femur, tibia, and fibula in claims databases.Methods: Patients from the IBM MarketScan Research Commercial and Medicare Databases receiving inpatient ORIF between 1 January 2010 and 31 January 2017 (index) were identified. Readmissions within 90 days were calculated starting from the index day of discharge to 2 days after discharge. Readmission rates were also reported after accounting for records for rehabilitation, aftercare, or transfer using discharge status, provider type, and Diagnosis Related Group (DRG) codes. For patients with "transferred" as the index hospitalization discharge status, readmissions were calculated 2 days after discharge.Results: A total of 82,692 patients with ORIF for femur, tibia or fibula were identified; mean (SD) age was 60.1 (23.1) years and nearly two-thirds were female (62.3%). For the index hospitalization, 41.6% patients had "transferred" as the discharge status. The readmission rate calculated from the same day as the discharge was 14.7%. Readmission rates calculated 1 and 2 days after index discharge were 8.5 and 7.7%. After accounting for rehabilitation, aftercare and transfer, the corrected readmission rate was 8.6%. Corrected readmission rates calculated 1 and 2 days after index discharge were 7.2 and 7.2%, respectively. The most common diagnosis associated with same day readmission was rehabilitation, whereas that was not observed with readmissions 1 and 2 days after discharge.Conclusions: The accuracy of identifying true admissions was improved by defining readmissions as occurring after the day of discharge and by accounting for rehabilitation, aftercare, and transfer.

Surgical treatment, complications, and reimbursement among patients with clavicle fracture and acromioclavicular dislocations: a US retrospective claims database analysis.

Aims: To assess rates of surgical treatment, post-surgical complications, reoperations, and reimbursement in patients with clavicle fractures and acromioclavicular (AC) dislocations. Materials and methods: This US retrospective study used data from patients with ≥1 diagnosis of clavicle fracture or AC dislocation (index) between 2012-2016. Surgical treatment was defined as a procedure within 4 weeks after clavicle fracture/AC dislocation. Rates of complications (infection, non-union, mal-union), reoperations (device removal or revisions), and all-cause healthcare reimbursement (adjusted to 2016$) were evaluated 2 years post-index among surgical patients. Results: A total of 95,243 patients with clavicle fracture and 52,100 patients with AC dislocation were identified. Mean (SD) age for clavicle fracture and AC dislocation was 23.8 (18.6) and 33.0 (15.6) years, respectively. Most clavicle fracture and AC dislocation patients were male (70.9% and 78.0%, respectively), and had few comorbidities (86.4% and 84.8% had a Charlson Comorbidity Index = 0 and 73.1% and 66.0% had Elixhauser = 0, respectively). Only 15.2% of clavicle fracture and 5.3% of AC dislocation patients received surgical treatment. Among patients undergoing surgical treatment, 2-year rates of infection, non-union, and mal-union were 1.0%, 4.2%, and 0.9%, respectively, for clavicle fracture, and 2.0%, 0.9%, and 0.1%, respectively, for AC dislocation. Reoperations occurred in 83.0% of clavicle fracture and 67.5% of AC dislocation patients. Mean (SD) 2-year reimbursement was $27,635 ($68,173) for clavicle fracture and $23,096 ($28,746) for AC dislocation. Limitations: Administrative claims data lack clinical information, limiting inferences that can be made. This data may not be generalizable to other patients. Conclusions: Rates of surgical treatment for clavicle fractures and AC dislocation and rates of infection, non-union, and mal-union among surgically-treated patients were low. However, surgical patients had high rates of device removal or revision surgery during 2-year follow-up. Improved surgical methods and technologies could reduce non-planned reoperations and device removals, thereby reducing healthcare system costs.