Uncovering the Risks: A Meta-Analysis Insight
Joint replacement surgeries are a beacon of hope for many, yet the journey doesn’t end in the operating room. A recent meta-analysis sheds light on the complex web of factors leading to rehospitalization within 90 days post-surgery. This comprehensive review is a crucial read for every medical professional involved in orthopedic care.
The Source Article Details
Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis by Liping Zeng et al. in 2023.
The Source Article's Abstract
The risk factors influencing the readmission within 90 days following total joint replacement (TJR) are complex and heterogeneous, and few systematic reviews to date have focused on this issue.
Web of Science, Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from the inception dates to December 2022. Relevant, published studies were identified using the following keywords: risk factors, rehospitalization, total hip replacement, total knee replacement, total shoulder replacement, and total joint replacement. All relevant data were collected from the studies that meet the inclusion criteria. The methodological quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS).
Of 68,336 patients who underwent TJR, 1,269,415 (5.4%) were readmitted within 90 days. High American Society of Anesthesiologists (ASA) class, heart failure, diabetes, liver disease, drinking, depression, urinary tract infection, and deep vein thrombosis showed statistically positive correlation with increased 90-day readmissions after TJR, but high blood pressure, smoking, and pneumonia had no significant association with readmission risk.
The findings of this review and meta-analysis will aid clinicians as they seek to understand the risk factors for 90-day readmission following TJR. Clinicians should consider the identified key risk factors associated with unplanned readmissions and develop strategies to risk-stratify patients and provide dedicated interventions to reduce the rates of readmission and enhance the recovery process.
The Source Article References
- Reducing hospital readmission disparities of older black and white adults after elective joint replacement: the role of nurse staffing. by Lasater, 2016 in J Am Geriatr Soc
- Reducing 30-day readmission after joint replacement. by Chambers, 2016 in Orthop Clin North Am
- Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. by Zmistowski, 2013 in J Bone Joint Surg Am
- Readmission, complication, and disposition calculators in total joint arthroplasty: a systemic review. by Howie, 2021 in J Arthroplasty
- Enhanced recovery after primary total hip and knee arthroplasty: a systematic review. by Morrell, 2021 in J Bone Joint Surg Am
- Outcomes of a first total knee arthroplasty are associated with outcomes of the subsequent contralateral total knee arthroplasty. by Schwarzkopf, 2020 in J Arthroplasty
- Are there identifiable risk factors and causes associated with unplanned readmissions following total knee arthroplasty? by Kheir, 2014 in J Arthroplasty
- Factors affecting readmission rates following primary total hip arthroplasty. by Mednick, 2014 in J Bone Joint Surg Am
- Association between body mass index and thirty-day complications after total knee arthroplasty. by George, 2018 in J Arthroplasty
- Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty. by Jensen, 2021 in Acta Orthop
- Predictors of 30-Day readmission after total knee arthroplasty: analysis of 566,323 procedures in the United Kingdom. by Ali, 2019 in J Arthroplasty
- Risk factors for early hospital readmission following total knee arthroplasty. by Lehtonen, 2018 in Acta Ortop Bras
- Risk factors predict increased length of stay and readmission rates in revision joint arthroplasty. by Keswani, 2016 in J Arthroplasty
- Are there modifiable risk factors for hospital readmission after total hip arthroplasty in a US healthcare system? by Paxton, 2015 in Clin Orthop Relat Res
- Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP. by Pugely, 2013 in J Arthroplasty
- All-Cause versus complication-specific readmission following total knee arthroplasty. by D’Apuzzo, 2017 in J Bone Joint Surg Am
- Tibiotalocalcaneal nailing for osteoporotic ankle fractures in the frail patient: a narrative review with a clinical score proposal for the decision-making process. by Herrera-Pérez, 2022 in EFORT Open Rev
- Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. by Pugely, 2013 in J Bone Joint Surg Am
- Preinjury ASA score as an independent predictor of readmission after major traumatic injury. by Tran, 2017 in Trauma Surg Acute Care Open
- Predictors of readmission after inpatient plastic surgery. by Jain, 2014 in Arch Plast Surg
Citing the Source Article (APA)
Zeng, L., Cai, H., Qiu, A., Zhang, D., Lin, L., Lian, X., Chen, M. (2023). Risk factors for rehospitalization within 90 days in patients with total joint replacement: A meta-analysis. Medicine (Baltimore), 102(45), e35743-e35743. 10.1097/MD.0000000000035743
The Crux of the Matter: Key Risk Factors Identified
Among the 68,336 patients analyzed, a significant 5.4% faced rehospitalization. The study pinpoints several risk factors, including high ASA class, heart failure, and diabetes. Interestingly, factors like high blood pressure and smoking showed no significant impact on readmission risks.
- High ASA Class: A clear indicator of increased rehospitalization risk.
- Heart Failure and Diabetes: These comorbidities significantly contribute to postoperative complications.
- Depression and Lifestyle Factors: Mental health and lifestyle choices like drinking play a crucial role in recovery trajectories.
Implications for Clinical Practice
The findings of this study are not just numbers but a call to action for clinicians. Understanding these risk factors is pivotal in developing targeted strategies for patient care, potentially reducing rehospitalization rates and enhancing recovery outcomes.
- Problem: Rehospitalization within 90 days following total joint replacement (TJR).
- Patient or Population: 68,336 patients who underwent TJR.
- Intervention: This is a meta-analysis, so the intervention is the analysis of various studies to identify risk factors for rehospitalization.
- Comparison: The study does not involve a direct comparison but rather an aggregation of data from multiple studies to identify common risk factors.
- Outcome: Identification of risk factors for 90-day rehospitalization after TJR, including high ASA class, heart failure, diabetes, liver disease, drinking, depression, urinary tract infection, and deep vein thrombosis.
- Number of Subjects: A total of 1,269,415 patients were analyzed across the included studies.
- Statistics: The study provides statistical correlations between various risk factors and the likelihood of rehospitalization within 90 days post-TJR.
Join the Conversation
What are your thoughts on these findings? How can we integrate this knowledge into our clinical practices to better support our patients post-surgery? Share your insights and experiences in the comments below.