April 17, 2015PLoS ONE122 citationsOpen Access

Thirty-Day Readmission Rates in Orthopedics: A Systematic Review and Meta-Analysis

JBJames T. Bernatz JTJonathan L. Tueting PAPaul A. Anderson

Structured PICO

Population

487,780 patients from 24 retrospective observational studies (26 unique patient populations) undergoing orthopedic procedures or admissions (including spine, arthroplasty, trauma, and general orthopedics).

Intervention

Orthopedic procedures or admissions

Outcome

30-day readmission rate (defined as admission to any service of any hospital within 30 days of either an orthopedic procedure or discharge from the orthopedic service)

The 30-day readmission rate in orthopedics is approximately 5.4%, with surgical site complications being the most common cause, highlighting a clear target for quality improvement initiatives.

Limitations

High heterogeneity between studies (I-squared > 90%)
Lack of generalizability in some studies due to single-hospital data or subset populations
Risk factors and causes of readmission were missing from greater than 75% of studies
Potential underreporting of readmissions if patients presented to different hospitals
Potential overstatement of unplanned readmissions by including planned readmissions for staged procedures

Abstract

BACKGROUND: Hospital readmission rates are being used to evaluate performance. A survey of the present rates is needed before policies can be developed to decrease incidence of readmission. We address three questions: What is the present rate of 30-day readmission in orthopedics? How do factors such as orthopedic specialty, data source, patient insurance, and time of data collection affect the 30-day readmission rate? What are the causes and risk factors for 30-day readmissions? METHODS/FINDINGS: A review was first registered with Prospero (CRD42014010293, 6/17/2014) and a meta-analysis was performed to assess the current 30-day readmission rate in orthopedics. Studies published after 2006 were retrieved, and 24 studies met the inclusion criteria. The 30-day readmission rate was extrapolated from each study along with the orthopedic subspecialty, data source, patient insurance, time of collection, patient demographics, and cause of readmission. A sensitivity analysis was completed on the stratified groups. The overall 30-day readmission rate across all orthopedics was 5.4 percent (95% confidence interval: 4.8,6.0). There was no significant difference between subspecialties. Studies that retrieved data from a multicenter registry had a lower 30-day readmission rate than those reporting data from a single hospital or a large national database. Patient populations that only included Medicare patients had a higher 30-day readmission rate than populations of all insurance. The 30-day readmission rate has decreased in the past ten years. Age, length of stay, discharge to skilled nursing facility, increased BMI, ASA score greater than 3, and Medicare/Medicaid insurance showed statistically positive correlation with increased 30-day readmissions in greater than 75 percent of studies. Surgical site complications accounted for 46 percent of 30-day readmissions. CONCLUSIONS: This meta-analysis shows the present rate of 30-day readmissions in orthopedics. Demonstrable heterogeneity between studies underlines the importance of uniform collection and reporting of readmission rates for hospital evaluation and reimbursement.

Ask AI

Helpful

Bookmark

View Full Paper