Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures

Formulating data from chart review; Drawing correlations
based on two tail tests.

Early last year, I had the opportunity to work with an orthopedic surgeon in conducting research on readmissions after open reduction-internal fixation of proximal humerus fractures. the goal was to identify potential sources of risk for this procedure. After hours reviewing charts, learning the vernacular of an orthopedic surgeon, compiling data, establishing correlations of statistical significance, and writing portions of the manuscript, I am excited to announce that our paper is finally published! Check out the link below!

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures

Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization

Edward Yian, MD; Hui Zhou, MS, PhD; Ariyon Schreiber; Jeff Sodl, MD; Ron Navarro, MD; Anshuman Singh, MD; Nikita Bezrukov, MD

Perm J 2016 Winter;20(1):47-52

Abstract

CONTEXT:

Surgical treatment for proximal humerus fractures has increased exponentially. Recent health care policies incentivize centers to reduce hospital readmission rates. Better understanding of risk factors for readmission and early mortality in this population will assist in identifying favorable risk-benefit patient profiles.

OBJECTIVE:

To identify incidence and risk factors of 30-day hospital readmission rate and 1-year mortality rate after open surgery of proximal humerus fractures.

DESIGN:

Retrospective cohort analysis from Kaiser Permanente Southern California Region database.

METHODS:

Using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes, all operative proximal humerus fractures were validated. Hospital readmission, one-year mortality, and demographic and medical data were collected. A logistic regression test was performed to assess potential risk factors for outcomes.

RESULTS:

From 1387 surgical patients, the 30-day all-cause readmission rate was 5.6%. Forty percent of hospital read-missions were due to surgery-related reasons. Severe liver disease (odds ratio [OR], 3.48, 95% confidence interval [CI] = 1.42-8.55) and LACE (length of stay, acuity of admission, comorbidities, and number of Emergency Department visits in the previous 6 months) index score ≥ 10 (OR, 4.47, 95% CI = 2.54-7.86) were independent risk factors of readmission on multivariate analysis. The 1-year mortality rate was 4.86%. Multivariate analysis showed length of hospital stay (OR 1.11, 95% CI = 1.05-1.19), cancer (OR 3.38, 95% CI = 1.61-7.10), 30-day readmission (OR 3.31, 95% CI = 1.34-8.21), and Charlson comorbidity index greater than or equal to 4 (OR 13.94, 95% CI = 4.40-44.17) predicted higher mortality risk.

CONCLUSION:

After open treatment of proximal humerus fractures, there was a 5.6% all-cause 30-day hospital readmission rate. Surgical complications accounted for 40% of read-missions. Severe liver disease and LACE score correlated best with postoperative 30-day readmission risk. Length of hospital stay, preexisting cancer, 30-day readmission, and Charlson comorbidity index were predictive of 1-year mortality.