30-day Readmission Research Articles

Trends and Safety of Same-day Discharge for Robot-assisted Laparoscopic Prostatectomy: A Comparison Between the Pre-pandemic and Pandemic Periods From the National Cancer Database

ObjectiveTo assess and compare the use of same-day discharge (SDD) for robot-assisted laparoscopic prostatectomy (RALP) between the "Pre-pandemic" and "Pandemic" periods and investigate SDD impact on mortality and readmissions. Materials and MethodsWe examined data from the National Cancer Database on men receiving RALP in the “Pre-pandemic” (2018-2019) and “Pandemic” (2020) periods. We analyzed the differences in patient and hospital characteristics between SDD and non-SDD patients. Multivariable logistic regression analysis was performed to evaluate the likelihood of SDD during "Pandemic" versus "Pre-pandemic" periods. Inverse probability treatment weighting (IPTW) was utilized to assess the impact of SDD on 30-day mortality, 90-day mortality, and 30-day readmissions, adjusting for patient and hospital characteristics. ResultsOut of 111,117 men, 8,997 (8%) received SDD. Patients with more comorbidities, non-private insurance, and high-risk prostate cancer reported lower SDD rates (p<0.001). Higher SDD rates were observed at academic facilities and those in the top RALP volume quartile (p<0.001). Patients who underwent RALP during the "Pandemic" period had increased odds of SDD compared to those receiving RALP in the "Pre-pandemic" period (aOR 1.37; 95%CI 1.31-1.45; p<0.001). When comparing SDD and non-SDD patient outcomes, after IPTW adjustment, there was no difference in the odds of 30-day mortality (aOR 0.98; 95%CI 0.47-2.01; p=0.95), 90-day mortality (aOR 1.09; 95%CI 0.60-1.97; p=0.76), or 30-day readmissions (aOR 0.90; 95%CI 0.76-1.06, p=0.21). ConclusionSDD for RALP increased steadily after pandemic. Identifying factors and necessary resources to standardize SDD for RALP will be crucial for its widespread adoption in the coming years.

Association of Social Determinants of Health With Hospital Readmission and Mortality: A Prospective Cohort Study.

The relative contributions of common patient-reported social determinants of health on 30- and 90-day post-discharge outcomes among patients with acute coronary syndromes (ACS) is unclear. The aim of this article is to examine the independent associations of social determinants with readmission or death, accounting for medical history. Participants included adults who were hospitalized with ACS at an academic medical center. Domains measured were social support, health literacy/numeracy, and socioeconomic status (SES) (including education and difficulty paying bills). We employed multivariable Cox proportional hazard models to study associations with time to all-cause readmission or death, up to 30 or 90 days after discharge, and adjusted for demographics and medical history (prior admissions and Elixhauser comorbidity index). Among 1,168 patients with ACS and no history of heart failure, more prior admissions, and higher comorbidity index (the medical history domain) were associated with higher rates of 30- and 90-day readmission or death (domain p values <.01 and <.0001, respectively). The social support domain was not associated with outcomes. Higher health literacy and numeracy were associated with lower rates of 30- and 90-day readmission or death (domain p values .016 and .002, respectively). Higher education and less difficulty paying bills (the SES domain) was marginally associated with lower rates of 90-day readmission or death (domain, p = .052). In addition to medical history, the domain of health literacy and numeracy was independently associated with readmission or death of patients with ACS during the 90 days after hospital discharge. [HLRP: Health Literacy Research and Practice. 2024;8(4):e212-e223.].

Primary and incisional hernias should be considered separately in clinical decisions and research: A nationwide register-based cohort study

BackgroundVentral hernias of umbilical, epigastric, and incisional types pose varied surgical challenges. Recent debates and research suggest that treatment strategies and outcomes may vary significantly based on hernia type and width. This study investigated whether differences in the risk of surgical outcomes among primary and incisional hernias are solely due to the hernia type. The primary outcome was reoperation for recurrence, and the secondary outcome was 90-day postoperative readmission. MethodsThis study was based on prospectively collected data from the Danish Ventral Hernia Database linked with the Danish Civil Registration system and the National Patient Register. Data spanned from 2007 to 2022 and included patients with umbilical, epigastric, or incisional hernias. The 3 hernia types were analyzed for the risk of reoperation for recurrence, adjusted for sex, age, emergency repair, width, use of mesh, and Charlson comorbidity index. ResultsWe included 57,312 hernias: 34,147 umbilical, 9,433 epigastric, and 13,722 incisional hernias. Compared with patients with umbilical hernias, patients with epigastric hernias had a lower risk of reoperation (hazard ratio: 0.88, 95% confidence interval: 0.79–0.99) and those with incisional hernias had an increased risk (hazard ratio: 2.93, 95% confidence interval: 2.57–3.33). Postoperative 90-day readmission rates were also higher for patients with incisional hernias than for patients with umbilical and epigastric hernias. ConclusionIncisional hernias exhibited a higher risk of reoperation for recurrence and 90-day postoperative readmission, underscoring their unique nature in terms of both origin and clinical behavior. The findings suggest that primary and incisional hernias should be separate entities in medical practice and research.

Bias in Prediction Models to Identify Patients With Colorectal Cancer at High Risk for Readmission After Resection

PURPOSE Machine learning (ML) algorithms are used for predictive modeling in medicine, but studies often do not evaluate or report on the potential biases of the models. Our purpose was to develop clinical prediction models for readmission after surgery in patients with colorectal cancer (CRC) and to examine their potential for racial bias. METHODS We used the 2012-2020 American College of Surgeons' National Surgical Quality Improvement Program Participant Use File and Targeted Colectomy File. Patients were categorized into four race groups—White, Black or African American, other, and unknown/not reported. Potential predictive features were identified from studies of risk factors of 30-day readmission in patients with CRC. We compared four ML-based methods—logistic regression, multilayer perceptron, random forest, and XGBoost (XGB). Model bias was assessed using false-negative rate (FNR) difference, false-positive rate (FPR) difference, and disparate impact (DI). RESULTS In all, 112,077 patients were included, 67.2% of whom were White, 9.2% Black, 5.6% other race, and 18% with race not recorded. There were significant differences in the area under the receiver operating characteristics curve, FPR, and FNR between race groups across all models. Notably, patients in the other race category had higher FNR compared with Black patients in all but the XGB model, while Black patients had higher FPR than White patients in some models. Patients in the other category consistently had the lowest FPR. Applying the 80% rule for DI, the models consistently met the threshold for unfairness for the other race category. CONCLUSION Predictive models for 30-day readmission after colorectal surgery may perform unequally for different race groups, potentially propagating to inequalities in delivery of care and patient outcomes if the predictions from these models are used to direct care.

Variation in physician spending and its association with postoperative outcomes among patients undergoing surgery for gastrointestinal cancer

BackgroundThere is significant variation in inpatient expenditures among physicians and hospitals. This study aimed to characterize the association between variation in physician spending and short-term outcomes among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) and colorectal cancer (CRC). MethodsPatients who underwent surgery for PDAC and CRC from 2010 to 2020 were identified using the Surveillance, Epidemiology, and End Result-Medicare–linked database. The cohort was divided into quartiles based on adjusted physician spending, and multivariate models were used to assess the association between physician spending and patient outcomes. ResultsAmong 27,596 Medicare beneficiaries, 25,615 (92.8%) underwent surgery for CRC and 1981 (7.2%) underwent surgery for PDAC. Of the variations in spending, 79.9% were due to patient-level factors, 13.3% were due to hospital characteristics, and 6.8% were due to surgeon-level variables. On multivariate analysis, there was no association between physician spending and 30-day readmission (with complications: first quartile [Q1], reference; Q4: odds ratio [OR], 1.10; 95% CI, 0.86–1.41; P = .123; without complications: Q1, reference; Q3, stage IV: OR, 0.97; 95% CI, 0.68–1.40; P = .882) or between physician spending and 30-day mortality (without complications: Q1, reference; Q2, stage I: OR, 1.17; 95% CI, 0.45–3.01; P = .804). However, an increase in physician spending was associated with higher 30-day mortality among patients with complications (Q1, reference; Q4: OR, 2.28; 95% CI, 1.72–3.03; P < .001). ConclusionThere was more variation in healthcare spending across hospitals than across individual physicians. No consistent association between variation in physician spending and patient outcomes was noted. Wasteful spending can be reduced through targeted interventions aimed at reducing variations at the physician and hospital levels.

Clinical and patient-reported outcomes following subtotal cholecystectomy: 10-year single-institution experience

ObjectiveSubtotal cholecystectomy provides a safe, bail-out alternative for difficult gallbladders. However, long-term outcomes comparing fenestrating and reconstituting subtotal cholecystectomy subtypes remain underexplored. MethodsThis retrospective cohort included patients who underwent subtotal cholecystectomy between 2010 and 2020 within a single hospital system. Subtotal cholecystectomy was identified by parsing operative notes for keywords. Demographic and clinical variables were collected by manual review. Patient-reported outcomes were collected via phone using an abbreviated Gastrointestinal Quality-of-Life Index. ResultsWe identified 218 subtotal cholecystectomies, with 113 (51.8%) fenestrating subtotal cholecystectomy and 105 (48.2%) reconstituting subtotal cholecystectomy and a median follow-up of 63 months (interquartile range 27–106). Rates of bile duct injury (0.9% vs 1.0%; P > .99), bile leak (10.6% vs 9.5%; P > .99), and 30-day readmission (7.6% vs 8.0%; P > .99) did not differ between fenestrating and reconstituting subtotal cholecystectomy. For fenestrating subtotal cholecystectomy, the postoperative bile leak rate decreased fourfold when cystic duct closure was achieved (6.0% vs 24.1%; P = .012). Subtotal cholecystectomies completed laparoscopically had fewer postoperative bile leaks (2.9% vs 16.8%; P = .001), fewer wound complications (4.8% vs 13.3%; P = .035), and decreased length of stay (7.00 ± 9.07 vs 10.15 ± 13.50 days; P < .001) compared with open operations. The survey response rate was 38.9% (n = 51/131); 47 patients (92.2%) did not report recurrent biliary pain or postprandial nausea or vomiting, but 19 patients (37.2%) reported dietary restriction. Long-term completion cholecystectomy rate was 0.9%. ConclusionGiven no notable difference in postoperative or quality of life outcomes between subtotal cholecystectomy subtypes, consideration of technique depends on intraoperative conditions. Cystic duct closure during fenestrating subtotal cholecystectomy and laparoscopic completion of subtotal cholecystectomy are associated with improved postoperative outcomes.

Enhancing readmission prediction models by integrating insights from home healthcare notes: Retrospective cohort study

BackgroundHospital readmission is an important indicator of inpatient care quality and a significant driver of increasing medical costs. Therefore, it is important to explore the effects of postdischarge information, particularly from home healthcare notes, on enhancing readmission prediction models. Despite the use of natural language processing (NLP) and machine learning in prediction model development, current studies often overlook insights from home healthcare notes. ObjectiveThis study aimed to develop prediction models for 30-day readmissions using home healthcare notes and structured data. In addition, it explored the development of 14- and 180-day prediction models using variables in the 30-day model. DesignA retrospective observational cohort study. Setting(s)This study was conducted at Ajou University School of Medicine in South Korea. ParticipantsData from electronic health records, encompassing demographic characteristics of 1819 participants, along with information on conditions, drug, and home healthcare, were utilized. MethodsTwo distinct models were developed for each prediction window (30-, 14-, 180-day): the traditional model, which utilized structured variables alone, and the common data model (CDM)-NLP model, which incorporated structured and topic variables extracted from home healthcare notes. BERTopic facilitated topic generation and risk probability, representing the likelihood of documents being assigned to specific topics. Feature selection involved experimenting with various algorithms. The best-performing algorithm, determined using the area under the receiver operating characteristic curve (AUROC), was used for model development. Model performance was assessed using various learning metrics including AUROC. ResultsAmong 1819 patients, 251 (13.80 %) experienced 30-day readmission. The least absolute shrinkage and selection operator was used for feature extraction and model development. The 15 structured features were used in the traditional model. Moreover, five additional topic variables from the home healthcare notes were applied in the CDM-NLP model. The AUROC of the traditional model was 0.739 (95 % CI: 0.672–0.807). The AUROC of the CDM-NLP model was high at 0.824 (95 % CI: 0.768–0.880), which indicated an outstanding performance. The topics in the CDM-NLP model included emotional distress, daily living functions, nutrition, postoperative status, and cardiorespiratory issues. In extended prediction model development for 14- and 180-day readmissions, the CDM-NLP consistently outperformed the traditional model. ConclusionsThis study developed effective prediction models using both structured and unstructured data, thereby emphasizing the significance of postdischarge information from home healthcare notes in readmission prediction.

Subjective Improvement of Reflux Symptoms After Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass and Concomitant Repair of Hiatal Hernia

BackgroundSymptoms of reflux after SG are common and may be refractory to medical treatment. ObjectivesTo assess outcomes of conversion of SG to RYGB with concomitant repair of hiatal hernias on symptoms of reflux. SettingTertiary Community Hospital MethodsWe reviewed data from all consecutive patients (2018-21) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and post-op PPI use were compared with McNemar statistical test. Data are mean± standard deviation. Results64 patients (92% female; 48±10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4±3 years after the index SG. A hiatal hernia was detected preoperatively in 57/64 patients (89%) by either UGI, CT scan or EGD.At 29±14 months post-conversion to RYGB, TBWL was 14±9%, EWL was 37±29%, BMI decreased from 37±7 to 32±6 Kg/m2. Symptoms of reflux and use of PPI improved during the early follow up period (median: 14 months; p<0.001) and was sustained at late follow up (median: 32 months; p<0.01). Improvement of nausea and dysphagia reached statistical significance at late follow up (median: 32 months; p<0.01). Vomiting and abdominal pain decreased with time but did not reach statistical significance.Post-op complications were deep surgical site infection (n=3), pulmonary embolism (n=1), bleeding (n=5), reoperation (n=3), and 30-day readmission (n=6). ConclusionsConversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.

Utility of Risk Analysis Index for Assessing Morbidity in Patients Undergoing Posterior Spinal Fusion for Adult Spinal Deformity

This study investigates the predictive values of the Risk Analysis Index (RAI), the modified 5-item Frailty Index (mFI-5), and advanced age for predicting 30-day extended length of stay (LOS), 30-day complications and readmissions in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD). A retrospective cohort study was performed using the 2012-2021 ACS NSQIP database. Adults undergoing posterior spinal fusion for ASD were identified using CPT and ICD codes. Using receiver operating characteristic (ROC) and multivariable analyses, we compared the discriminative thresholds and independent associations of RAI, mFI-5, and greater patient age for extended LOS, 30-day complications and readmissions. In this cohort of 3,814 patients, RAI identified 90.7% as Robust, 6.0% as Normal, and 3.3% as Frail/Very Frail, while mFI-5 classified 47.1% as Robust, 37.5% as Normal, and 15.3% as Frail/Very Frail. Multivariate analysis revealed both RAI and mFI-5 as significant predictors of extended LOS for Normal (RAI: p<0.001; mFI-5: p=0.012) and Frail/Very Frail patients (RAI: p<0.001; mFI-5: p=0.002). Additionally, RAI was a significant predictor of 30-day complication risk for Normal patients (p=0.005). Furthermore, mFI-5 was a significant predictor of 30-day readmission among Frail/Very Frail patients (p=0.002). This study highlights the utility of RAI and mFI-5 in predicting extended LOS patients undergoing PSF for ASD. RAI was found to be superior to mFI-5 for predicting 30-day readmissions, while mF-5 was greater for 30-day complications. These findings highlight the importance of incorporating frailty assessments into preoperative surgical planning.

A Nonrandomized Pilot Study to Investigate the Acceptability and Feasibility of LivR Well: A Multifaceted 28-Day Home-Based Liver Optimization Program for Acute-on-Chronic Liver Failure

Background and AimsAcute-on-chronic liver failure (ACLF) has a 22-74% 28-day mortality rate and 30-40% 30-day re-admission rate. We investigated the acceptability and feasibility of a multimodal community intervention for ACLF. MethodsA single-arm, non-randomized pilot study of consecutive participants with ACLF was conducted in a tertiary health service. Participants received weekly medical and nursing reviews, dietetics, physiotherapy, pharmacy, social work, addiction medicine, and/or neuropsychiatry. A digital platform included remote weight monitoring, and online surveys. The primary outcome was acceptability/feasibility. Secondary outcomes included safety, mortality, re-admission, liver disease severity, and costs. ResultsFifty-nine patients were enrolled with median age 51 years (IQR: 45-59); majority alcohol etiology (74%),and median Model for End-Stage Liver Disease Sodium (MELD-Na) score 16 (IQR: 12-21). LivR Well was acceptable with low attrition (8/59), adherence to the program including home visits (mean 8.4±4.2) and consultations (mean 2.4±1.5) per patient. This was supported by positive feedback and themes identified through a qualitative sub-analysis. Feasibility was demonstrated by recruitment rate of 4.94 patients/month and 86% completion. Mortality was lower than expected at 3%, 30-day readmission rate was 15%, and median MELD-Na score reduced to 15 (p = 0.01). Median 6-month costs reduced from $30,454 (IQR: 21953-$65657) to $17, 657 ($4249-42876) (p=0.009). The total 6-month healthcare cost was $1,868,859 (95% CI 1,081,821-2,655,897) compared to $2,518,227 (95% CI 1,959,610-3,076,844). ConclusionLivR Well was acceptable, feasible and safe with low short-term mortality and readmission rates. Healthcare costs were reduced by 26% driven by a 40% reduction in 30-day re-admission. Further evaluation includes a randomized, controlled trial of LivR Well compared to standard care.

Risk factors for early readmission to hospital in patients with malignancy-related ascites: a retrospective cohort study.

Malignancy-related ascites (MRA) is a common serious complication of many advanced malignant tumors with high morbidity and mortality. The high hospital expenditures induced by unplanned readmission in patients with MRA have become an urgent issue to the public. We aimed to overall assess the unplanned early readmission rate of patients with MRA and explore the potential risk factors for such readmission. A retrospective cohort study based on 2018 Nationwide Readmissions Database was performed and patients with MRA were recruited into the analysis. The primary outcome was unplanned 30-day readmission rate and inpatient outcomes. The multivariate logistic regression analysis was performed to evaluate the potential risk factors for such early readmission. Data obtained from 32,457 patients with MRA were analyzed, and of these 7,799 individuals (24.03%) were unplanned readmitted within 30-day follow-up. The mortality rate in the readmitted population was 15.15%. Patients at younger age were at a higher risk of readmission. The morbidities including hypertension (OR=1.117, 95%CI: 1.054-1.184), hyperlipemia (OR=1.075, 95%CI: 1.009-1.146) and diabetes (OR=1.118, 95%CI: 1.053-1.188), gastrointestinal malignancies and peritoneal procedure significantly increased the risk of 30-day readmission in patients with MRA. More than one in five patients with MRA was unplanned readmitted within 30-day follow-up. The above risk factors should be timely intervened and the corresponding medical care should be strengthened in patients with MRA to lessen the unplanned readmission and improve the readmission outcomes.

Predicting frailty domain impairments and mortality with the Hospital Frailty Risk Score among older adults with cancer: the ELCAPA-EDS cohort study.

Automated frailty screening tools like the Hospital Frailty Risk Score (HFRS) are primarily validated for care consumption outcomes. We assessed the predictive ability of the HFRS regarding care consumption outcomes, frailty domain impairments and mortality among older adults with cancer, using the Geriatric 8 (G8) screening tool as a clinical benchmark. This retrospective, linkage-based study included patients aged ≥70years with solid tumor, enrolled in the Elderly Cancer Patients (ELCAPA) multicentre cohort study (2016-2020) and hospitalized in acute care within the Greater Paris University Hospitals. HFRS scores, which encompass hospital-acquired problems and frailty-related syndromes, were calculated using data from the index admission and the preceding 6months. A multidomain geriatric assessment (GA), including cognition, nutrition, mood, functional status, mobility, comorbidities, polypharmacy, incontinence, and social environment, was conducted at ELCAPA inclusion, with computation of the G8 score. Logistic and Cox regressions measured associations between the G8, HFRS, altered GA domains, length of stay exceeding 10days, 30-day readmission, and mortality. Among 587 patients included (median age 82years, metastatic cancer 47.0%), 237 (40.4%) were at increased frailty risk by the HFRS (HFRS>5) and 261 (47.5%) by the G8 (G8≤10). Both HFRS and G8 were significantly associated with cognitive and functional impairments, incontinence, comorbidities, prolonged length of stay, and 30-day mortality. The G8 was associated with polypharmacy, nutritional and mood impairment. Although showing significant associations with short-term care consumption, the HFRS could not identify polypharmacy, nutritional, mood and social environment impairments and showed low discriminatory ability across all GA domains.

Disparities in neighborhood deprivation and patient reported quality of life relating to post-operative sequelae after radical cystectomy.

141 Background: Readmissions following radical cystectomy(RC) remain high despite prehabilitation and enhanced recovery after surgery (ERAS) care. Recently, studies have shown the correlation between socioeconomic neighborhood deprivation (ND) and post-operative quality of life (QoL) in oncologic surgeries. We sought to examine the impact of preoperative QoL and ND with postoperative sequela following RC. Methods: This was a prospective IRB approved study of patients undergoing RC for bladder cancer from 2021 to 2023. QoL was assessed with the FACT-Bl-Cys survey. Clinicopathologic, complication, and readmission data were collected up to 90 days, as well as distance from the hospital and 4 zip-code based Indices (1-100 index scores representing socioeconomic deprivation). FACT-BL-Cys and indices scores were correlated with outcomes of interest. Pairwise Spearman correlation was done between indices and QoL Instruments. A multivariable analysis (MVA) identified the factors that influence complications and readmissions. Results: The cohort consisted of 56 patients, mostly men (n=40, 71%). Median age was 69, most had organ-confined disease (≤(y)pT2N0M0, n =45, 80%) and underwent neoadjuvant chemotherapy (n=32, 57%). 75% underwent a continent diversion (neobladder n=38, 68% or continent cutaneous diversion n=4, 7%). Median follow-up time was 10.1 months (range 3.7 - 16.7 months). No correlation was observed between 30/90-day complications or readmissions with FACT-BL-Cys. Healthy Places Index (HPI) correlated with overall QoL and subscores. On MVA, correlation was seen between Social Deprivation Index (SDI) and 90-day readmissions (p=0.03, OR=0.97, 95%CI= 0.94-0.99). Conclusions: Patient-reported QoL aligns with diverse socioeconomic strata, as per deprivation indices, which in turn correlate with readmissions. Further studies are needed to understand the relationship between patient reported QoL and ND with postoperative outcomes. Correlation between zip code-based deprivation indexes and quality of life scores. Well Being Scores Distance to Hospital HPI DCI SDI Physical 0.35 (p=0.01) 0.28 (p=0.05) -0.22 (p=0.11) -0.15 (p=0.27) Social 0.00 (p= 0.97) 0.10 (p=0.46) -0.11 (p=0.40) -0.10 (p=0.49) Emotional -0.07 (p=0.62) -0.18 (p=0.21) 0.19 (p=0.15) 0.22 (p=0.11) Functional 0.28 (p=0.04) 0.36 (p=0.01 ) -0.26 (p=0.05) -0.16 (p=0.24) BL-CYS 0.13 (p=0.36) 0.23 (p=0.10) -0.11 (p=0.42) -0.04 (p=0.79) TOI (PWB+FWB+BL-CYS) 0.26 (p=0.06) 0.34 (p=0.01) -0.22 (p=0.10) -0.13 (p=0.33) FACT-BL-CYS Total Score 0.19 (p=0.16) 0.31 (p=0.03) -0.20 (p=0.13) -0.11 (p=0.42) HPI: Healthy Places Index, DCI: Distressed Communities Index, SDI: Social Deprivation Index, ADI: Area Deprivation Index.

The Impact of Travel Distance on Patient-Reported Outcomes Following Primary Total Hip Arthroplasty

BackgroundTotal hip arthroplasties (THAs) are increasingly being performed at high-volume centers, causing some patients to travel further distances to receive care. Concerns remain that increased travel distance limits follow-up, which may impact outcomes and early return to the hospital. The purpose of this study is to evaluate the impact of travel distance on 90-day patient-reported outcomes (PROs) and 90-day complication rates. MethodsPatients undergoing inpatient primary THA at a single center by one of three surgeons between 2017 and 2021 were retrospectively reviewed. Patients whose local and distant medical records were available were included. Patients who lived ≥ 40 miles from the location or follow-up were labeled as “travelers,” and those < 40 miles were “locals.” Primary outcomes included PROs as measured by Veterans Rand 12 Item Health Survey, Harris Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement. Secondary outcomes included rates of 90-day medical complications, emergency department visits, unplanned readmissions, and reoperations. ResultsA total of 413 patients were analyzed at a mean of 897.1 days (range, 92 to 2,196) including 96 travelers. Travelers averaged 96.1 miles for follow-up (range, 40.1 to 678 miles), and locals averaged 14.1 miles for follow-up (range, 0.3 to 39.8 miles). There were no differences in the percentage of patients achieving minimal clinically important difference in PROs. There was no difference in the rate of 90-day medical complications, 90-day readmissions, and reoperations. Local patients were significantly more likely to have unplanned postoperative emergency department visits (travelers = 0%, locals = 7.4%, P = 0.003). ConclusionsTravelers did not demonstrate any significant differences with respect to rates of achieving minimal clinically important difference in PROs or 90-day complication rates. These data suggest that increased travel distance to treatment centers does not impact outcomes following primary THA.

Medical- and Implant-Related Complications Following Total Joint Arthroplasty in Patients Who Have Chronic Lymphocytic Leukemia

BackgroundChronic lymphocytic leukemia (CLL) is highly prevalent in the Total Joint Arthroplasty (TJA) age group but has not been properly evaluated. This study aims to assess: 1) 90-day medical complications; 2) implant-related complications; 3) healthcare utilization; and 4) time to revision in CLL and non-CLL TJA. MethodsChronic Lymphocytic Leukemia cases undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were identified using diagnostic and procedural codes. CLL TKA and THA patients were matched 1:5 with controls based on demographics and comorbidities. Outcomes included 90-day medical complications, 2-year implant complications, length of stay (LOS), 90-day readmission, and time to revision. ResultsThe CLL TKA patients had significantly higher odds of 90-day medical complications compared to controls, notably pneumonia (OR, 9.2; CI, 7.1 to 12.0; P < 0.001) and myocardial infarction (OR, 5.5; CI, 3.9 to 7.9; P < 0.001). Similarly, CLL THA patients had greater odds of 90-day medical complications, especially pneumonia (OR 10.0; CI 8.2 to 12.2; P < 0.001) and acute kidney injury (AKI) (OR 6.3; CI 5.1 to 7.8; P < 0.001). CLL TKA patients faced higher odds of periprosthetic fracture, mechanical loosening, and prosthetic joint infection, while THA patients had increased periprosthetic fractures. Revisions occurred earlier for THA than TKA (337 ± 547 days versus 643 ± 774 days). CLL patients had longer LOS (TKA: 5.9 ± 6.5 versus 3.1 ± 1.6 days; P < 0.001) (THA: 6.3 ± 12.9 versus 3.0 ± 2.4; P < 0.001) and higher 90-day readmission rates (OR, 1.3; CI, 1.1 to 1.5, P < 0.001). ConclusionsOrthopaedic surgeons should consider CLL status for informed patient counseling and complications mitigation.

S1672 Evaluating the Impact of Palliative Care Consultation on 30- and 90-Day Readmissions Among Patients With Decompensated Cirrhosis: A National Perspective

S1672 Evaluating the Impact of Palliative Care Consultation on 30- and 90-Day Readmissions Among Patients With Decompensated Cirrhosis: A National Perspective

A Higher Area Deprivation Index is Associated with Increased Medical Complications and Emergency Department Utilizations after Total Hip Arthroplasty

IntroductionThe Area Deprivation Index (ADI) is a weighted index comprised of 17 census-based markers of material deprivation and poverty. The purpose of this study was to determine whether patients undergoing total hip arthroplasty (THA) in areas of high ADI (greater disadvantage) were associated with differences in 90-day: 1) medical complications; 2) emergency department (ED) utilizations; and 3) readmissions. MethodsA nationwide database was queried for primary THA patients from 2010 to 2020. The ADI is reported on a scale of 0 to 100, with higher numbers indicating greater disadvantage. Patients undergoing primary THA in regions associated with high ADI (90%+) were compared to those of lower ADI (0 to 89%). A total of 138,670 patients were evenly matched between the two cohorts following 1:1 propensity score matching by age, sex, and Elixhauser Comorbidity Index (ECI). Primary endpoints were 90-day medical complications, ED utilizations, and readmissions. Multivariable logistic regression models calculated the odds ratios (OR) and 95% confidence intervals (95% CI). P-values less than 0.01 were statistically significant. ResultsPatients undergoing THA from high ADI had significantly higher rates and odds of developing any medical complications (13.00 versus 11.91%; OR: 1.09, P < 0.0001), including acute kidney injuries (1.83 versus 1.52%; OR: 1.20, P < 0.0001), myocardial infarctions (0.35 versus 0.24%; OR: 1.45, P = 0.0003), and surgical site infections (0.94 versus 0.76%; OR: 1.23, P = 0.0004). High ADI patients had significantly higher rates and odds of ED visits within 90 days (3.94 versus 3.67%; OR: 1.08, P = 0.008). There was no significant difference in readmissions (5.44 versus 5.69%; OR: 0.95, P = 0.034). ConclusionsSocioeconomically disadvantaged patients have increased odds of 90-day medical complications and ED utilizations, despite comparable 90-day readmission rates. Measures of neighborhood disadvantage may be valuable metrics to inform healthcare policy and improve post-discharge care.

Age Does Not Impact Cancer Specific Mortality: From Sub-Distributional and Cause-Specific Hazard Analysis in RCC Patients Undergoing Radical Nephrectomy and Thrombectomy

ObjectiveTo evaluate the impact of age on cancer-specific mortality (CSM) and other-cause mortality (OCM) in patients undergoing radical nephrectomy with thrombectomy (RNTx) for renal cell carcinoma (RCC) with venous thrombus. Patients and MethodsWe retrospectively analyzed data from 196 patients who underwent RNTx for RCC with venous thrombus between 1990 and 2018 at a single tertiary referral center. Patients were grouped into three age groups: <60 years, 60-69 years, and ≥70 years. Clinical and pathological characteristics were compared. The cumulative incidence function (CIF) for CSM and OCM was calculated using the Aalen-Johansen estimator. We employed both sub-distributional hazard (SDH) and cause-specific hazard (CSH) models to evaluate the impact of age on mortality, using hazard ratios (HR) and 95% confidence intervals (CI) quantified associations. ResultsThe median follow-up was 40.5 months. During this time, 105 patients experienced disease progression, 125 had cancer-related deaths, and 155 deceased from any cause. Perioperative outcomes, including ICU admission, 90-day readmission, and 90-day mortality, showed no significant differences among age groups. The CIF for CSM revealed significant differences at 5-year (p = 0.032) but not at 10-years (p = 0.246). OCM increased with age, notably in the oldest group at 10 years (p = 0.045). Multivariable adjusted CSH and SDH models showed no significant differences in CSM among age groups. ConclusionAlthough the CIF for 5-year CSM and 10-year OCM were associated with increasing age, aging does not increase the hazard of CSM in both SDH and CSH models. Perioperative outcome does not differ between all age groups. For RCC with venous thrombus patients, older age alone is not absolute contraindication for surgical intervention. Micro-AbstractThis study assessed the impact of age on cancer-specific and other-cause mortality in patients undergoing radical nephrectomy with thrombectomy for renal cell carcinoma with venous thrombus. Although older age was associated with higher other-cause mortality at 10 years, age did not significantly affect cancer-specific mortality, suggesting that age should not be a contraindication for surgery in these patients. Perioperative outcomes were similar across all age groups.

Osteoporosis May Not Be an Absolute Contraindication for Cementless Total Knee Arthroplasty

BackgroundCementless total knee arthroplasty (TKA) has received growing interest, particularly in younger populations, due to potential long-term survivability and improved bone preservation. Poor bone stock, as seen in osteoporosis, is considered a contraindication for this technique. This study evaluated whether osteoporotic patients < 75 years undergoing cementless TKA demonstrate similar 1) implant-related complications, 2) medical complications, 3) readmission rates, and 4) 3-year implant survivability. MethodsA retrospective query of a national administrative claims database was performed between 2010 and 2022 for patients less than or equal to 75 years old who have osteoporosis and underwent primary TKA. Osteoporotic patients were divided into cementless and cemented cohorts, and propensity scores were matched based on age, sex, obesity, and the Charleston Comorbidity Index (CCI). Matching produced 7,923 patients (1,321 uncemented, 6,602 cemented). Multivariate logistic regressions evaluated the following outcomes: 90-day and 2-year implant-related complications, 90-day postoperative medical complications, and 90-day readmissions. Kaplan-Meier survival analysis was conducted to assess 3-year all-cause revision implant survivability. The significance threshold was set to P < 0.01 to minimize type 1 bias. ResultsThere were no statistically significant differences in implant-related complications, medical complications, readmissions, and lengths of stay between cementless and cemented TKA groups. Kaplan-Meier analysis demonstrated statistically similar 3-year survivability between cohorts (cemented: 97.6%, CI [confidence interval] 96.6 to 98.5; cementless: 97.2%, CI 96.7 to 97.7; P = 0.472). ConclusionPatients who have osteoporosis have equivalent medical and implant-related complications as well as 3-year implant survival following cementless TKA compared with a cemented technique. Our results support cementless TKA as a viable option for patients < 75 years, regardless of prior diagnosis of osteoporosis. Intraoperative decisions regarding bone quality are still necessary to discriminate between those who are candidates for cementless TKA with those who are not.

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients

IntroductionOrthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures. Materials and MethodsA cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits. ResultsIn total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively. ConclusionsIn a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.