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A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty.

Publication ,  Journal Article
Goltz, DE; Ryan, SP; Howell, CB; Attarian, D; Bolognesi, MP; Seyler, TM
Published in: J Arthroplasty
May 2019

BACKGROUND: Evolving reimbursement models increasingly compel hospitals to assume costs for 90-day readmission after total joint arthroplasty. Although risk assessment tools exist, none currently reach the predictive performance required to accurately identify high-risk patients and modulate perioperative care accordingly. Although unlikely to perform adequately alone, the Elixhauser index is a set of 31 variables that may lend value in a broader model predicting 90-day readmission. METHODS: Elixhauser comorbidities were examined in 10,022 primary unilateral total joint replacements, of which 4535 were hip replacements and 5487 were knee replacements, all performed between June 2013 and January 2018 at a single tertiary referral center. Data were extracted from electronic medical records using structured query language. After randomizing to derivation (80%) and validation (20%) subgroups, predictive models for 90-day readmission were generated and transformed into a system of weights based on each parameter's relative performance. RESULTS: We observed 497 90-day readmissions (5.0%) during the study period, which demonstrated independent associations with 14 of the 31 Elixhauser comorbidity groups. A score created from the sum of each patient's weighted comorbidities did not lose substantial predictive discrimination (area under the curve: 0.653) compared to a comprehensive multivariable model containing all 31 unweighted Elixhauser parameters (area under the curve: 0.665). Readmission risk ranged from 3% for patients with a score of 0 to 27% for those with a score of 8 or higher. CONCLUSIONS: The Elixhauser comorbidity score already meets or exceeds the predictive discrimination of available risk calculators. Although insufficient by itself, this score represents a valuable summary of patient comorbidities and merits inclusion in any broader model predicting 90-day readmission risk after total joint arthroplasty. LEVEL OF EVIDENCE: III.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

May 2019

Volume

34

Issue

5

Start / End Page

857 / 864

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics
  • North Carolina
  • Middle Aged
  • Male
  • Humans
  • Female
 

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Chicago
ICMJE
MLA
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Goltz, D. E., Ryan, S. P., Howell, C. B., Attarian, D., Bolognesi, M. P., & Seyler, T. M. (2019). A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty. J Arthroplasty, 34(5), 857–864. https://doi.org/10.1016/j.arth.2019.01.044
Goltz, Daniel E., Sean P. Ryan, Claire B. Howell, David Attarian, Michael P. Bolognesi, and Thorsten M. Seyler. “A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty.J Arthroplasty 34, no. 5 (May 2019): 857–64. https://doi.org/10.1016/j.arth.2019.01.044.
Goltz DE, Ryan SP, Howell CB, Attarian D, Bolognesi MP, Seyler TM. A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty. J Arthroplasty. 2019 May;34(5):857–64.
Goltz, Daniel E., et al. “A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty.J Arthroplasty, vol. 34, no. 5, May 2019, pp. 857–64. Pubmed, doi:10.1016/j.arth.2019.01.044.
Goltz DE, Ryan SP, Howell CB, Attarian D, Bolognesi MP, Seyler TM. A Weighted Index of Elixhauser Comorbidities for Predicting 90-day Readmission After Total Joint Arthroplasty. J Arthroplasty. 2019 May;34(5):857–864.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

May 2019

Volume

34

Issue

5

Start / End Page

857 / 864

Location

United States

Related Subject Headings

  • Risk Assessment
  • Retrospective Studies
  • Postoperative Complications
  • Patient Readmission
  • Orthopedics
  • North Carolina
  • Middle Aged
  • Male
  • Humans
  • Female