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01-09-2018 | Original Paper

Re-admissions treble the risk of late mortality after primary total hip arthroplasty

Authors: Pablo A. Slullitel, Martín Estefan, Wilber M. Ramírez-Serrudo, Fernando M. Comba, Gerardo Zanotti, Francisco Piccaluga, Martín A. Buttaro

Published in: International Orthopaedics | Issue 9/2018

Abstract

Background

Following a total hip arthroplasty (THA), early hospital re-admission rates of 3–11% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of re-admissions on mortality has not been priorly portrayed. Therefore, we sought to determine the mortality rate after 90-day re-admissions following a THA in a series of patients from a captive medical care program.

Patients and methods

We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated upon between 2010 and 2014 whose medical care was the one offered by our institution. We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazards model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with early and late mortality.

Results

We found 37 (4.53%) re-admissions at a median time of 40.44 days (IQR 17.46–60.69). Factors associated with re-admission were hospital stay (p = 0.00); surgical time (p = 0.01); chronic renal insufficiency (p = 0.03); ASA class 4 (p = 0.00); morbid obesity (p = 0.006); diabetes (p = 0.04) and a high Charlson index (p = 0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR 297.58–1170.65). One-third (11/37) of the re-admitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day re-admissions remained associated with mortality with an adjusted HR of 3.14 (CI95% 1.05–9.36, p = 0.04).

Conclusions

Unplanned re-admissions were an independent risk factor for future mortality, increasing three times the risk of mortality.

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Title: Re-admissions treble the risk of late mortality after primary total hip arthroplasty
Authors: Pablo A. Slullitel
Martín Estefan
Wilber M. Ramírez-Serrudo
Fernando M. Comba
Gerardo Zanotti
Francisco Piccaluga
Martín A. Buttaro
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 9/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3876-0

At a glance: The STEP trials

Springer Medicine

Re-admissions treble the risk of late mortality after primary total hip arthroplasty

Abstract

Background

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusions

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