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A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty.

Publication ,  Journal Article
Goltz, DE; Ryan, SP; Hopkins, TJ; Howell, CB; Attarian, DE; Bolognesi, MP; Seyler, TM
Published in: J Bone Joint Surg Am
March 20, 2019

BACKGROUND: A reliable prediction tool for 90-day adverse events not only would provide patients with valuable estimates of their individual risk perioperatively, but would also give health-care systems a method to enable them to anticipate and potentially mitigate postoperative complications. Predictive accuracy, however, has been challenging to achieve. We hypothesized that a broad range of patient and procedure characteristics could adequately predict 90-day readmission after total joint arthroplasty (TJA). METHODS: The electronic medical records on 10,155 primary unilateral total hip (4,585, 45%) and knee (5,570, 55%) arthroplasties performed at a single institution from June 2013 to January 2018 were retrospectively reviewed. In addition to 90-day readmission status, >50 candidate predictor variables were extracted from these records with use of structured query language (SQL). These variables included a wide variety of preoperative demographic/social factors, intraoperative metrics, postoperative laboratory results, and the 30 standardized Elixhauser comorbidity variables. The patient cohort was randomly divided into derivation (80%) and validation (20%) cohorts, and backward stepwise elimination identified important factors for subsequent inclusion in a multivariable logistic regression model. RESULTS: Overall, subsequent 90-day readmission was recorded for 503 cases (5.0%), and parameter selection identified 17 variables for inclusion in a multivariable logistic regression model on the basis of their predictive ability. These included 5 preoperative parameters (American Society of Anesthesiologists [ASA] score, age, operatively treated joint, insurance type, and smoking status), duration of surgery, 2 postoperative laboratory results (hemoglobin and blood-urea-nitrogen [BUN] level), and 9 Elixhauser comorbidities. The regression model demonstrated adequate predictive discrimination for 90-day readmission after TJA (area under the curve [AUC]: 0.7047) and was incorporated into static and dynamic nomograms for interactive visualization of patient risk in a clinical or administrative setting. CONCLUSIONS: A novel risk calculator incorporating a broad range of patient factors adequately predicts the likelihood of 90-day readmission following TJA. Identifying at-risk patients will allow providers to anticipate adverse outcomes and modulate postoperative care accordingly prior to discharge. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

March 20, 2019

Volume

101

Issue

6

Start / End Page

547 / 556

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • ROC Curve
  • Prevalence
  • Predictive Value of Tests
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics
 

Citation

APA
Chicago
ICMJE
MLA
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Goltz, D. E., Ryan, S. P., Hopkins, T. J., Howell, C. B., Attarian, D. E., Bolognesi, M. P., & Seyler, T. M. (2019). A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty. J Bone Joint Surg Am, 101(6), 547–556. https://doi.org/10.2106/JBJS.18.00843
Goltz, Daniel E., Sean P. Ryan, Thomas J. Hopkins, Claire B. Howell, David E. Attarian, Michael P. Bolognesi, and Thorsten M. Seyler. “A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty.J Bone Joint Surg Am 101, no. 6 (March 20, 2019): 547–56. https://doi.org/10.2106/JBJS.18.00843.
Goltz DE, Ryan SP, Hopkins TJ, Howell CB, Attarian DE, Bolognesi MP, et al. A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty. J Bone Joint Surg Am. 2019 Mar 20;101(6):547–56.
Goltz, Daniel E., et al. “A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty.J Bone Joint Surg Am, vol. 101, no. 6, Mar. 2019, pp. 547–56. Pubmed, doi:10.2106/JBJS.18.00843.
Goltz DE, Ryan SP, Hopkins TJ, Howell CB, Attarian DE, Bolognesi MP, Seyler TM. A Novel Risk Calculator Predicts 90-Day Readmission Following Total Joint Arthroplasty. J Bone Joint Surg Am. 2019 Mar 20;101(6):547–556.

Published In

J Bone Joint Surg Am

DOI

EISSN

1535-1386

Publication Date

March 20, 2019

Volume

101

Issue

6

Start / End Page

547 / 556

Location

United States

Related Subject Headings

  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • ROC Curve
  • Prevalence
  • Predictive Value of Tests
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics