Key result
Outpatient rotator cuff repair yields a ~1% 30-day readmission rate, driven largely by dialysis dependence.
Why the study?
Patient characteristics that increase risk for unplanned 30-day readmission after outpatient rotator cuff repair were not well defined.
What patient characteristics increase the risk for 30-day unplanned readmission following outpatient rotator cuff repair?
Cohort (n=18,061)
Yes
What patient characteristics increase the risk for 30-day unplanned readmission following outpatient rotator cuff repair?
Advanced age and preexisting medical comorbidities, particularly dialysis and hypertension, significantly increase the risk of 30-day unplanned readmission following outpatient rotator cuff repair.
May support outpatient rotator cuff repair safety; dialysis and ASA class 4 associations are observational and require prospective validation before changing selection.
OBJECTIVES: The purpose of this study is to identify patient characteristics that increase risk for unplanned readmission within 30 days of an initial hospital stay after outpatient rotator cuff repair (RCR). METHODS: A retrospective cohort study was performed utilizing the National Surgical Quality Improvement Program (ACS NSQIP) datasets from 2012 to 2015. Patients were preliminarily included in the study based on the presence of a primary Common Procedural Terminology code for RCR (23410, 23412, 23420, and 29827). Only non-emergent, outpatient, and elective procedures performed on patients with American Society of Anesthesiologists (ASA) ≤4 were considered. The primary outcome variables were 30-day unplanned readmission after outpatient surgery. Secondary analyses were implemented to establish reason and timing of readmission. RESULTS: A total of 18,061 cases were reviewed, and 199 (1%) patients experienced 30-day unplanned readmission. Age ≥80 (OR = 2.13, p = 0.0276), COPD (OR = 1.75, p = 0.0354), hypertension requiring medication (OR = 1.67, p = 0.0027), dialysis (OR = 13.46, p < 0.0001) and an ASA classification of 3 (OR = 2.78, p = 0.0143) or ASA 4 (OR = 6.15, p = 0.0012) were identified as major prognosticators for readmission. Female sex was associated with lower odds of readmission (OR = 0.54, p = 0.0001). The most common complications associated with readmission were cardiovascular (29%), infection (19%), and respiratory (17%). CONCLUSIONS: The rate of 30-day unplanned inpatient readmission following outpatient RCR using the NSQIP data was found to be 1%, with advanced age and preexisting medical comorbidities contributing to the highest odds of readmission. Cardiovascular, infectious, and respiratory complications contributed to the majority of readmissions. The ability to identify patients with these risk factors will be of utility in optimizing outcomes and cost-effectiveness of RCR. LEVEL OF EVIDENCE: Level III.
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Kosinski et al. (2018) conducted a cohort in Outpatient rotator cuff repair (n=18,061). Patient characteristics and comorbidities (e.g., age ≥80, COPD, hypertension, dialysis, ASA class) vs. Absence of these risk factors was evaluated on 30-day unplanned readmission after outpatient surgery. The 30-day unplanned readmission rate following outpatient rotator cuff repair was 1%, with dialysis (OR 13.46) and ASA class 4 (OR 6.15) identified as major prognosticators for readmission.
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