Alcohol Abuse, Morbid Obesity, Depression, Congestive Heart Failure, and Chronic Pulmonary Disease are Risk Factors for 90-Day Readmission After Arthroscopic Rotator Cuff Repair

Gagan Grewal; Teja Polisetty; Dylan Cannon; Andrew Ardeljan; Rushabh M Vakharia; Hugo C Rodriguez; Jonathan C Levy

doi:10.1016/j.asmr.2022.06.015

Alcohol Abuse, Morbid Obesity, Depression, Congestive Heart Failure, and Chronic Pulmonary Disease are Risk Factors for 90-Day Readmission After Arthroscopic Rotator Cuff Repair

Arthrosc Sports Med Rehabil. 2022 Aug 26;4(5):e1683-e1691. doi: 10.1016/j.asmr.2022.06.015. eCollection 2022 Oct.

Authors

Gagan Grewal¹, Teja Polisetty¹, Dylan Cannon¹, Andrew Ardeljan², Rushabh M Vakharia¹, Hugo C Rodriguez¹, Jonathan C Levy¹

Affiliations

¹ Holy Cross Orthopedic Institute, Fort Lauderdale, Florida, U.S.A.
² NOVA Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, Florida, U.S.A.

Abstract

Purpose: The purpose of this study was to report the rate and causes of 90-day readmissions after arthroscopic rotator cuff repair.

Methods: A retrospective query from January 2005 to March 2014 was performed using a nationwide administrative claims registry. Patients and complications were identified using International Classification of Disease, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Patients who underwent arthroscopic rotator cuff repair (RCR) and were readmitted within 90 days after their index procedure were identified. Patients not readmitted represented controls. Patients readmitted were stratified into separate cohorts depending on the primary cause of readmission, which included cardiac, endocrine, hematological, infectious, gastrointestinal, musculoskeletal (MSK), neoplastic, neurological or psychiatric, pulmonary, and renal. Risk factors assessed were comorbidities comprising the Elixhauser-Comorbidity Index (ECI). Primary outcomes analyzed and compared included cause for readmission, patient demographics, risk factors, in-hospital length of stay (LOS), and costs. Pearson's chi-square was used to compare patient demographics, and multivariate binomial logistic regression was used to calculate odds ratios (OR) on patient-related risk factors for 90-day readmissions.

Results: 10,425 readmitted patients and 301,625 control patients were identified, representing a 90-day readmission rate of 3.5%. The causes of readmissions were primarily related to infectious diseases (15%), MSK (15%), and cardiac (14%) complications. The most common MSK readmissions were osteoarthrosis of the leg or shoulder (24.8%) and spinal spondylosis (8.4%). Multivariate binomial logistic regression analyses demonstrated patients with alcohol abuse (OR, 1.42; P < .0001), morbid obesity (OR, 1.38; P < .0001), depression (OR, 1.35; P < .0001), congestive heart failure (OR, 1.34; P < 0.0001), and chronic pulmonary disease (OR, 1.28; P < .0001) were at the greatest risk of readmissions after RCR.

Conclusions: Significant differences exist among patients readmitted, and those patients who do not require hospital readmission within 90 days following arthroscopic rotator cuff repairs. Readmissions are associated with significant patient comorbidities and were primarily related to medically based complications.

Level of evidence: Level III, prognostic, retrospective cohort study.