Predictors of 30-Day Re-hospitalization After Total Hip and Total Knee Arthroplasty: A Orthopedic Ward Perspective
Year 2022,
Volume: 12 Issue: 1, 227 - 234, 30.03.2022
Ebru Gelişgen
Pakize Özyürek
Abstract
Objective: The study was aimed to elucidate risk factors identifiable from ward-derived data of thirty-day re-hospitalization among patients undergoing total hip and total knee arthroplasty.
Methods: The study was designed as a cross-sectional and prospective study. The data of the study were collected through the Patient Sociodemographic Form, the Nurse Physical Assessment and Observation Form, the Charlson Comorbidity Index (CCI), and the Katz Activities of Daily Living (ADL) Scale.
Results: Patients were scored using this CCI system and grouped as high (high CCI group >2, n = 49) and low CCI (low CCI group ≤2, n = 78) with a cut-off score of 2. The 30-day re-hospitalization rate was 14.2%, and the most common reason for re-hospitalization was a surgical infection.
Surgical risk, Activities of daily living dependency, and comorbidities index scores of the patients were not significantly additive effects on rehospitalization (p> 0.05). The results indicate that surgical infection was often the cause of higher rates of re-hospitalization among patients with total knee and total hip arthroplasty.
Conclusions: Conclusions: Orthopedic nurses should close observation of surgical site infection and design an effective discharge following-up order to the prevention of re-hospitalization in patients with“high risk”.
Supporting Institution
YOk
Thanks
The authors would like to thank the participating inpatients in an orthopedic clinic for their support and aid. Particular thanks also to all of the orthopedic nurses, doctors, and hospital management for their understanding and cooperation.
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versus complication-specific readmission following total knee
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Patient-related risk factors for unplanned 30-day readmission
following total knee arthroplasty: a protocol for a systematic
review and meta-analysis. BMJ 2019;8(1):1-8.
Year 2022,
Volume: 12 Issue: 1, 227 - 234, 30.03.2022
Ebru Gelişgen
Pakize Özyürek
References
- 1] OECD Indicators. Hip and knee replacement, in Health at a
Glance 2017. OECD Publishing, 2017, Paris, [cited 2020 Oct].
Avalaible from: URL: https://doi.org/10.1787/health_glance-
2017-65-en.
- [2] Truntzer N, Shah K, Jenkins D, Rubin L. Total joint arthroplasty in
patients with chronic infectious liver disease. Arthroplast Today
2016;2(2):69–76.
- [3] Fernandez-Cuadros ME, Perez-Moro OS, Miron-Canelo JA.
Age and comorbidities affect quality of life in patients with
osteoarthrtitis and knee replacement. Middle East Journal of
Rehabilitation and Health Studies 2016;3(4):e40247.
- [4] Gronbeck C, Cote MP, Lieberman JR, Halawi, M. Risk
stratification in primary total joint arthroplasty: the current
state of knowledge. Arthroplast Today 2019;5(1):126-131.
- [5] Loth FL, Giesinger JM, Giesinger K, MacDonald DJ, Simpson AH,
Howie CR, Hamilton DF. Impact of comorbidities on outcome
after total hip arthroplasty. J Arthroplasty 2017;32(9): 2755-
2761.
- [6] Causey-Upton R, Howell DM, Kitzman HP. Custer MG, Dressler
VD. Factors influencing discharge readiness after total knee
replacement. Orthop Nurs 2019; 38(1): 6-14.
- [7] Chern A, Greenberg ES, Thakore RV, Sathiyakumar V,
Obremskey VT, Sethi MK. Factors driving readmissions in tibia
and femur fractures. Adv Orthop 2015;74543: 1-6.
- [8] Bernatz JT, Tueting J, Anderson PA. Thirty-day readmission
rates in orthopedics: a systematic review and meta-analysis.
PLoS ONE 2015;10(4):e0123593.
- [9] Longo UG, Matarese M, Arcangeli V, Alciati V, Candela V,
Facchinetti G, Marchetti A, De Marinis MG, Denaro, V.
Denaro family caregiver strain and challenges when caring
for orthopedic patients: a systematic review. Journal Clinical
Medicine 2020; 9(1497): 2-19.
- [10] Avram V, Petruccelli D, Winemaker M, Beer J. Total joint
arthroplasty readmission rates and reasons for 30-day hospital
readmission. J Arthroplasty 2014; 29(3):465-468.
- [11] Gardona RGB, Barbosa DA. The importance of clinical practice
supported by health assessment tools. Rev Paul Enferm
2018;71(4):1815-1816.
- [12] Alzaghari O, Wallace DC. The impact of physiological factors
on 30-day unplanned rehospitalization in adults with heart
failure. J Community Health Nurs 2019;36(1):31-41.
- [13] Kurtz MS, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT.
Which hospital and clinical factors drive 30 – and 90-day
readmission after TKA? J Arthroplasty 2016;31(10): 2099-
2107.
- [14] Zadzilika JD, Kilika KA, Calvo C, Suarez JC, Patel PD, Krebs VE.
Caregiver burden for patients with severe osteoarthritis
significantly decreases by one year after total knee
arthroplasty. J Arthroplasty 2018;33(12):3660-3665.
- [15] Ural A, Kılıç İ. Bilimsel Araştırma Süreci ve Spss ile Veri Analizi.
4.Baskı. Ankara: Detay Yayıncılık; 2013. (Turkish)
[16] Özdamar K. SPSS ile Bioistatistik. 4. Baskı. Eskişehir: Nisan
Kitabevi; 2001.
- [17] Gültekin M, Şimşek, E. Palyatif bakımda ağrı yönetimi. T.C.
Sağlık Bakanlığı (2018,May 4). Available from: URL: http://
www.palyatifbakim.org.tr/images/klavuzlar/AGRI.pdf
- [18] Ozyurek P, Yavuz M , Yıldız Ö. Investigation of the risk factors
of pressure ulcers in intensive care unit patients: According to
the Braden Scale. East J Med 2016;21(1):1-9.
- [19] Barış VK, İntepeler S, İleri S, Rastgel H. İTAKİ Psikometrik
Özelliklerin Değerlendirilmesi. DEUHFED 2020;13(4):214-221.
(Turkish)
- [20] Roffman CE, Buchanana J, Allison GT. Charlson Comorbidities
Index. J Physiother 2016;62(3): 242.
- [21] ASA Physical Status Classification System. The ASA House of
Delegates. 2020 Aug 25. Available from: URL: ///C:/Users/
User/Downloads/asa-physical-status-classification-system.
pdf.
- [22] Pehlivanoğlu EÖ, Özkan MU, Balcıoğlu H, Bilge U. Adjustment
and reliability of Katz Daily Life Activity measures for elderly in
Turkish. Ankara Medical Journal 2018;18(2):219-23.
- [23] Ramkumar PN, Chu CT, Harris JD, Athiviraham A, Harrington
MA, White DL, Berger DH, Naik AD, Li, L.T. Causes and rates
of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop 2015; 44(9):397-405.
- [24] Martin CT, Gao Y, Pugely AJ. Incidence and risk factors for 30-
day readmissions after hip fracture surgery. Iowa Orthop J
2016;36:155-200.
- [25] Ramaswamy A, Marchese M, Cole AP, Harmouch S,
Friedlander D, Weissman JS, Lipsitz SR, Haider AH, Kibel AS,
Schoenfeld AJ, Trinh, Q. Comparison of hospital readmission
after total hip and total knee arthroplasty vs spinal surgery
after implementation of the hospital readmissions reduction
program. JAMA Network Open 2019;2(5):1-11.
- [26] Schairer WW, Sing DC, Vail TP, Bozic KJ. Causes and frequency
of unplanned hospital readmission after total hip arthroplasty.
Clin Orthop Relat Res 2014;472(2):464–70.
- [27] Kelly MP, Calkins TE, Culvern C, Kogan M, Della Valle CJ.
Inpatient versus outpatient hip and knee arthroplasty: which
has higher patient satisfaction? J Arthroplasty 2018;33(11):
3402-3406.
- [28] Varacallo MA, Herzog L, Toossi N, Johanson NA. Ten-year trends
and independent risk factors for unplanned readmission
following elective total joint arthroplasty at a large urban
academic hospital. J Arthroplasty 2017;32(6):1739–1746.
- [29] D’Apuzzo M, Westrich G, Hidaka C, Pan TJ, Lyman S. All-cause
versus complication-specific readmission following total knee
arthroplasty. Arch Bone Jt Surg 2017, 99(13):1093-1103.
- [30] Gould D, Dowsey M, Spelman T, Jo I, Kabir W, Trieu J, Choong, P.
Patient-related risk factors for unplanned 30-day readmission
following total knee arthroplasty: a protocol for a systematic
review and meta-analysis. BMJ 2019;8(1):1-8.