Risk Factors for Unexpected Hospital Admission Following Achilles Tendon Repair: A National Database Study

Author:

Tarazi John M.12ORCID,Partan Matthew J.12,Aminov Areil1,Sherman Alain E.13,Bitterman Adam D.12,Cohn Randy M.124

Affiliation:

1. Donald & Barbara Zucker School of Medicine at Hofstra/Northwell

2. Northwell Health—Huntington Hospital

3. NYC Health + Hospitals Lincoln

4. Northwell Health—Long Island Jewish Valley Stream

Abstract

INTRODUCTION Achilles tendon rupture (ATR) repair is one of the most common orthopaedic surgeries performed in the United States, however there is a paucity of literature on predisposing risk factors for hospital readmissions. The purpose of this study is to identify risk factors for 30-day readmission in patients undergoing ATR repair with emphasis on procedures performed in the outpatient setting. Specifically, we examine: 1) 30-day post-operative hospital readmission rates; 2) the medical comorbidities and patient characteristics that predisposed this cohort to post-operative complications; and 3) the complications leading to readmission.  METHODS The ACS-NSQIP was queried for patients who underwent ATR from 2015 to 2019 using CPT code 27650 in all fields yielding a sample size of 3,887 cases. The following demographic, lifestyle, and comorbidity variables were recorded: age, sex, race, BMI, morbid obesity (BMI ≥ 40.00 kg/m2), bleeding disorders, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, tobacco use, and chronic steroid use. The primary outcome of 30-day readmission was defined as unplanned hospital readmission likely related to the principal procedure. Independent samples Student’s t-tests, chi-squared, and, where appropriate, Fisher’s exact tests were used in univariate analyses to identify demographic, lifestyle, and peri-operative variables related to 30-day readmission following ATR. Multivariate logistic regression modeling was subsequently performed. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and reported. RESULTS Of the 3,887 patients included in our sample, 28 were readmitted within the 30-day post-operative period, corresponding to a readmission rate of 0.73%. Significant relationships with univariate analyses between readmission status and the following patient variables included: mean patient age (p = 0.02); hypertension (p < 0.001); BMI (p = 0.01); morbid obesity (p = 0.002); ASA Classification (p = 0.006); and bleeding disorders (p = 0.03). Multivariate logistic regression modeling confirmed that the following patient variables were associated with statistically significantly increased odds of readmission: age, p = 0.02), OR = 1.03, 95% CI [1.01, 1.06]; hypertension, p < 0.001, OR = 3.82, 95% CI [1.81, 8.06]; BMI, p = 0.01, OR = 1.06, 95% CI [1.01, 1.11]; morbid obesity, p = 0.004, OR = 3.53, 95% CI [1.49, 8.36]. CONCLUSION Our study indicated that only 0.73% of patients were readmitted after their outpatient procedure. Patients who: 1) have BMIs greater than 40; 2) are older in age 3) have hypertension; and 4) a higher ASA Classification were at increased risk for readmission.

Publisher

Charter Services New York d/b/a Journal of Orthopaedic Experience and Innovation

Reference14 articles.

1. American College of Surgeons National Surgical Quality Improvement Program;Improvement Q,2014

2. Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair;Hiroyuki Oda;Sports Medicine,2016

3. Risk factors for complications after primary repair of Achilles tendon ruptures;Christian A. Pean;Journal of Orthopaedics,2018

4. Low Risk for Local and Systemic Complications After Primary Repair of 1626 Achilles Tendon Ruptures;Nicholas Rensing;Foot & Ankle Specialist,2016

5. Postoperative Complications Following Repair of Acute Achilles Tendon Rupture;X. J. Ruben Stavenuiter;Foot & Ankle International,2019

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