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Prediction of Adverse Outcomes Within 90 Days of Surgery in a Heterogeneous Orthopedic Surgery Population
Insights
The LACE+ index effectively predicts unplanned readmissions and adverse outcomes in orthopedic surgery patients. This tool can help identify high-risk individuals for proactive interventions, improving patient care post-orthopedic procedures.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Patient Outcomes
Background:
- The LACE+ index is a known predictor of hospital readmissions.
- Validation of the LACE+ index for extended postoperative outcomes in orthopedics is lacking.
- Proactive identification of at-risk orthopedic patients is crucial for reducing preventable readmissions.
Purpose of the Study:
- To evaluate the LACE+ index's ability to predict unplanned readmissions after orthopedic surgery.
- To assess the LACE+ index's efficacy in forecasting adverse outcomes in orthopedic patients.
- To determine if LACE+ scores can identify patients at higher risk for postoperative complications.
Main Methods:
- Retrospective analysis of 18,893 orthopedic surgery patients from 2016-2018.
- Calculation of LACE+ scores at discharge for all included patients.
- Coarsened exact matching and quartile-based analysis to compare outcomes.
Main Results:
- Higher LACE+ scores significantly predicted 90-day readmissions and emergency department visits.
- Significant prediction of readmissions and ED visits was observed for 30-90 days post-discharge.
- Higher LACE+ scores also predicted reoperations, specifically between the highest quartiles (Q4 vs. Q3).
Conclusions:
- The LACE+ index demonstrates accuracy in predicting adverse outcomes post-orthopedic surgery.
- LACE+ scores can identify patients at high risk for readmission and other complications.
- This risk-prediction tool may aid in developing targeted interventions for orthopedic patients.
Introduction:
The LACE+ index has been shown to predict readmissions; however, LACE+ has not been validated for extended postoperative outcomes in an orthopedic surgery population. The purpose of this study is to examine whether LACE+ scores predict unplanned readmissions and adverse outcomes following orthopedic surgery. Use of the LACE1 index to proactively identify at-risk patients may enable actions to reduce preventable readmissions.
Methods:
LACE+ scores were retrospectively calculated at the time of discharge for all consecutive orthopedic surgery patients (n = 18,893) at a multicenter health system over 3 years (2016-2018). Coarsened exact matching was used to match patients based on characteristics not assessed in the LACE+ index. Outcome differences between matched patients in different LACE quartiles (i.e. Q4 vs. Q3, Q2, and Q1) were analyzed.
Results:
Higher LACE+ scores significantly predicted readmission and emergency department visits within 90 days of discharge and for 30-90 days after discharge for all studied quartiles. Higher LACE+ scores also significantly predicted reoperations, but only between Q4 and Q3 quartiles.
Conclusions:
The results suggest that the LACE+ risk-prediction tool may accurately predict patients with a high likelihood of adverse outcomes after a broad array of orthopedic procedures.
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