Unplanned Readmissions Following Outpatient Hand and Elbow Surgery: N/A - Not a clinical study

Abstract

Royalty: Skeletal Dynamics (Kakar)Consulting Fee: Arthrex, Skeletal Dynamics (Kakar)Contracted Research: Arthrex (Kakar) Readmission following surgery is a quality metric tracked by many institutions including Government agencies. The incidence of readmission following outpatient hand and elbow surgery is not reported. We utilized the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to determine the incidence of unplanned thirty-day readmission and the associated perioperative characteristics of patients undergoing outpatient hand and elbow surgery. The ACS-NSQIP database was queried to identify patients undergoing outpatient hand and elbow surgery between 2011 and 2013. The patients were identified using 407 hand-and-elbow-specific CPT codes. NSQIP captures 30-day readmissions that take place at the index hospital as well as any other hospital. Patients who underwent any other concomitant surgery were excluded from the analysis. Patients who required an unplanned readmission were compared with those who were not readmitted. Preoperative patient characteristics, intraoperative variables, days from procedure to discharge, 30-day complication rates, and mortality were compared between the cohorts. An a = 0.001 denoted statistical significance due to the large sample size. A total of 18,174 outpatient hand and elbow surgeries were identified between 2011 and 2013 of which 202 patients (1.1%) required an unplanned readmission. Patients who required readmission were significantly older (58 vs. 50 yr; P < 0.001) and experienced longer operative time (80 vs. 64 mins; P < 0.001). Pre-operative comorbidities including diabetes, hypertension, COPD, renal dialysis, and steroid use were more prevalent in the readmitted cohort (P < 0.001). Likewise, ASA class 3 and 4 were more prevalent in the readmitted cohort (P < 0.001). These patients had greater incidences of postoperative morbidity and mortality (P < 0.001). The incidence of unplanned readmission following outpatient hand and elbow surgery is low. Nevertheless, patients who were readmitted experienced higher incidences of postoperative complications and mortality. These data may be helpful for risk stratification of these patients prior the surgery. Further analysis is warranted to characterize the independent predictors of readmission following outpatient hand and elbow surgery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)