Factors associated with 30-day complication, reoperation, readmission, and length of stay after primary total elbow arthroplasty: a database study of 555 patients

Abstract

BackgroundThe indications for total elbow arthroplasty (TEA) have dramatically evolved in recent years, and factors associated with episode-of-care outcomes after TEA are not well-described in contemporary patients. The primary objective of this study was to identify factors associated with 30-day postoperative complication following primary TEA. Secondary objectives of this study were to identify factors associated with reoperation, hospital readmission, and hospital length of stay. MethodsA retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology code for TEA from 2014 to 2020. The resultant cohort of 555 patients who underwent primary TEA during the study period was included. The primary outcome was a composite variable encompassing all 30-day complication metrics measured by the National Surgical Quality Improvement Program, and secondary outcome variables were reoperation, readmission, and length of stay. A bivariate screen was performed for explanatory variables associated with our outcome variables, and variables with P < .1 in the bivariate screen were included in multivariable regression models. ResultsOf the 555 patients in our cohort, 53 patients (9.5%) developed a complication, 32 patients (5.8%) developed a complication not including blood transfusion, 22 patients (4.0%) underwent reoperation, and 28 patients (5.1%) were readmitted during the 30-day postoperative period. Of the 364 patients who underwent inpatient TEA, median hospital length of stay was 2 days. Multivariable logistic regression analysis showed longer operative time and diabetes mellitus were associated with complication, and lower body mass index was associated with readmission. Male sex was associated with reoperation in the bivariate analysis, and no other variables qualified for inclusion in a multivariable logistic regression model. Multivariable regression analysis showed that higher American Society of Anesthesiologists classification was associated with longer hospital length of stay. ConclusionShort-term postoperative complications following primary TEA are associated with operative time, which may represent surgical difficulty and/or surgeon experience, and diabetes mellitus. Male patients are at higher risk for reoperation, and patients with lower body mass index are at higher risk for hospital readmission. When TEA is performed as an inpatient procedure, length of stay is associated with patient comorbidities. We identified no differences among various indications for TEA in episode-of-care outcomes. Our findings are relevant for preoperative risk stratification and counseling.