11 Mar RATHRR Scale Predicts Readmission After Total Hip Replacement Risk
MedicalResearch.com Interview with:
Ronald S. Chamberlain, MD, MPA, FACS
Chairman and Surgeon-in-Chief
Department of Surgery
Saint Barnabas Medical Center
Professor of Surgery
New Jersey Medical School
MedicalResearch.com: What is the background for this study?
Dr. Chamberlain: With the rapidly growing arthritic, aging, and obese population, total hip replacement (THR) has become the most commonly performed orthopedic procedure in the United States (US). The Affordable Care Act signed by President Barack Obama imposed financial penalties for excess readmissions following certain procedures and diagnoses. While the initial program aimed to reduce readmissions for heart failure, pneumonia, and acute myocardial infarction (AMI), the program expanded to include THR in 2015. With current research estimating a 10%, 30-day readmission rate following a total or partial hip replacement, this study sought to identify factors associated with readmission and to create a scale which could reliably stratify preoperative readmission risk.
MedicalResearch.com: What are the main findings?
Dr. Chamberlain: A total of 268,518 hip replacements patients from the State Inpatient Database (SID) were analyzed, and factors associated with an increased risk of readmission were used to create the Readmission After Total Hip Replacement Risk (RATHRR) Scale. The RATHRR Scale was applied to a validation cohort of 153,560 total hip replacement patients and predicted readmission risk with 89.1% accuracy. Elderly patients 71 years and older, African Americans, and those with multiple comorbidities were determined to be independently associated with increased readmission rates following THR.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Chamberlain: Given current scrutiny of healthcare spending in the US and the expansion of the Hospital Readmission Reduction Program to include THR, the RATHRR Scale, would allow clinicians to use demographic and clinicopathological factors to identify high-risk patients for 30-day readmissions during the index admission and permit individualized care programs before and after surgery. By reducing readmission rates using risk stratifications, the RATHRR Scale should increase quality of care for patients, while reducing overall healthcare expenditures.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Chamberlain: While this study has been validated using a large, diverse sample and from various geographic locations, future research would involve validating the RATHRR Scale using smaller, unique populations that may not be representative of the entire US. In meeting the recent trend and success with mhealth technology, a smartphone application for the RATHRR Scale has been developed.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Chamberlain: The RATHRR Scale should be implemented as a tool to identify high-risk THR patients for 30-day readmission to allow precautionary and preventative care prior to or during the index admission.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Siracuse BL, Chamberlain RS. A Preoperative Scale for Determining Surgical Readmission Risk After Total Hip Replacement. JAMA Surg. Published online March 09, 2016. doi:10.1001/jamasurg.2016.0020.
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Ronald S. Chamberlain (2016). RATHRR Scale Predicts Readmission After Total Hip Replacement Risk MedicalResearch.com