Siracuse and Chamberlain reported a score for predicting surgical readmission following a total hip replacement (THR). This can help to identify a patient who may benefit from more aggressive management. The authors are from Saint Barnabas Medical Center (Livingston, New Jersey), Duke University, Rutgers University and Saint George's University (Grenada, West Indies).
Patient selection: total hip replacement for painful arthritis, fracture or osteonecrosis in adult > 40 years of age
Outcome: readmission (time interval not specified)
Parameters identified prior to joint replacement surgery:
(1) age in years
(2) income by quartile
(3) race
(4) revision procedure
(5) liver disease
(6) congestive heart failure (CHF)
(7) chronic pulmonary disease
(8) renal failure
(9) uncomplicated diabetes
(10) fluid and electrolyte disorder
(11) anemia (iron deficiency, blood loss)
(12) rheumatoid arthritis
(13) coagulopathy
(14) hypertension
(15) obesity
Items 5 to 15 are comorbidities.
|
Parameter |
Finding |
Points |
|
age in years |
41 to 70 |
0 |
|
|
71 to 80 |
6 |
|
|
81 to 90 |
14 |
|
|
>= 91 |
18 |
|
income in quartile |
first quartile |
3 |
|
|
second to fourth |
0 |
|
race |
African American |
3 |
|
|
other |
0 |
|
revision |
no |
0 |
|
|
yes |
12 |
|
liver disease |
no |
0 |
|
|
yes |
8 |
|
congestive heart failure |
no |
0 |
|
|
yes |
7 |
|
chronic pulmonary |
no |
0 |
|
|
yes |
5 |
|
renal failure |
no |
0 |
|
|
yes |
4 |
|
uncomplicated diabetes |
no |
0 |
|
|
yes |
3 |
|
fluid/electrolyte disorder |
no |
0 |
|
|
yes |
3 |
|
anemia |
no |
0 |
|
|
yes |
3 |
|
rheumatoid arthritis |
no |
0 |
|
|
yes |
3 |
|
coagulopathy |
no |
0 |
|
|
yes |
3 |
|
hypertension |
no |
0 |
|
|
yes |
3 |
|
obesity |
no |
0 |
|
|
yes |
2 |
where:
• Complicated diabetes is not listed as a comorbidity.
total score =
= SUM(points for all 15 parameters)
Interpretation:
• minimum score: 0
• maximum score: 80 (> 95% of patients had a score < 30).
• The text says that the maximum score is 100, but this score can only be reached if all age scores are tallied (a person >= 91 given a score of 18+14+6).
• The higher the score the greater the risk for readmission.
line for expected readmission rate over range 0 to 40 =
= (0.4627 * (score)) + 0.969
line for observed readmission rate over range 0 to 30 =
= (0.36 * (score)) + 2.73
where:
• A curved line seems to approximate the data better.
