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RATeS (Re-Admissions in Trauma and Orthopaedic Surgery): a prospective regional service evaluation of complications and readmissions

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

All the surgeries carry risks, which may lead to readmission at a later date. At present, there is limited Trauma and Orthopaedic (T&O) specific data in the literature. As a result, a prospective regional service evaluation aimed to discover the current complication and readmission rates across all T&O procedures and identify any factors associated with these outcomes.

Methods

Data were collected at six sites across Yorkshire and Humber for all T&O procedures during October 2016. Patient demographics and procedure-specific data were collected. Post-operative complications and length of stay were recorded. All the patients were then followed up for 30 days post-discharge to determine if they experienced complications which resulted in readmission and further surgical intervention.

Results

1411 patients having a total of 64 operations were recorded with 1391 completing follow-up (98.5%). Overall in-patient complication rate was 8.4% with the readmission rate being 4.4%. An ASA grade of three or more was found to be associated with readmission. Procedure-related factors such as the use of VTE prophylaxis and prophylactic antibiotics, as well as the elective nature of certain operations were negatively associated with readmission. The largest subgroup of patients was those undergoing total hip (THR) or knee replacements (TKR). For these 234 patients, the readmission rate for TKR and THR being 3.77% and 3.13%, respectively.

Conclusions

This large, multi-centre project describes readmission rates following trauma and orthopaedic surgery. In the presented study, the elective nature of the procedure was associated with a reduced risk of readmission.

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Acknowledgements

The authors would like to thank the 62 collaborators and the clinical governance departments at each site without whom this regional service evaluation would not have been possible. A search for publications under the terms “Complication rates from orthopaedic surgery”, by David Ashbey on 28/4/17. DONCASTER, UK: Doncaster & Bassetlaw Teaching Hospitals NHS Foundation Trust Knowledge, Library and Information Service. Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Sheffield. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry; (2) audit trails for tracking data manipulation and export procedures; (3) automated export procedures for seamless data downloads to common statistical packages; and (4) procedures for importing data from external sources.

Writing group: Alex E. Ward, Rebecca H. Hawes, Emma Whitehall, John Shepherd, Natalie Hopka & Azhar A. Merchant. Project steering group: Alex E. Ward, Rebecca H. Hawes, Emma Whitehall, John Shepherd, Ahmed Daoub, Beth Lineham, Matthew Stone, Richard Morris, Tom Hine, Aron Thomas, Chiraag Pandya, Natalie Hopka. Local collaborating authors [PubMed citable]: Alam, J., Aldoori, J., Alexander, H., Amarnani, R., Amos, L., Awera, O., Bradley C., Buckley, S., Chan, R., D’Souza, T., Daoub, A., Dominguez de Juan, L., Edwards, K., Euru, N., Foulkes, E., Fowler, G.E., Gould, B., Hawes, R.H., Hehnel, J., Hine, T., Hopka, N., Houghton, A., Huntington, G., Jalil, S., Jamjoom, A., Jayasuriya, R., Jenko, N., Kadri, S., Kaur, A., Kellay, K., Khan, A., Kocheta, A., Kubanova, B., Kucharski, R., Lineham, B., Luesley, A., Maxwell, M., Merchant, A.A., Mitchell, B., Moore, S., Morris, R., Nanavati, N., Ogunro, H., Panbehchi, S., Pandya, C., Pantelias, C., Parry, S., Ramaswamy, R., Ryder, L., Salih, S., Sargeant, T., Seddon, A., Sharma, S., Shepherd, J., Simpson, J., Srinivas-Murthy, A., Stone, M.J., Thomas, A., Tredgold, J., Ward, A.E., Wartenberg, K., Whitehall, E., Williams, D., Zuraw, N.

Funding

This project has received no funding.

Author information

Authors and Affiliations

  1. South Yorkshire Surgical Research Group (SYSuRG), Sheffield Medical School, South Yorkshire, S10 2RX, UK

    Alex E. Ward

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  1. Alex E. Ward
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Consortia

RATeS Study Group

  • J. Alam
  • , J. Aldoori
  • , H. Alexander
  • , R. Amarnani
  • , L. Amos
  • , O. Awera
  • , C. Bradley
  • , S. Buckley
  • , R. Chan
  • , T. D’Souza
  • , A. Daoub
  • , L. Dominguez de Juan
  • , K. Edwards
  • , N. Euru
  • , E. Foulkes
  • , G E. Fowler
  • , B. Gould
  • , R. H. Hawes
  • , J. Hehnel
  • , T. Hine
  • , N. Hopka
  • , A. Houghton
  • , G. Huntington
  • , S. Jalil
  • , A. Jamjoom
  • , R. Jayasuriya
  • , N. Jenko
  • , S. Kadri
  • , A. Kaur
  • , K. Kellay
  • , A. Khan
  • , A. Kocheta
  • , B. Kubanova
  • , R. Kucharski
  • , B. Lineham
  • , A. Luesley
  • , M. Maxwell
  • , A. A. Merchant
  • , B. Mitchell
  • , S. Moore
  • , R. Morris
  • , N. Nanavati
  • , H. Ogunro
  • , S. Panbehchi
  • , C. Pandya
  • , C. Pantelias
  • , S. Parry
  • , R. Ramaswamy
  • , L. Ryder
  • , S. Salih
  • , T. Sargeant
  • , A. Seddon
  • , S. Sharma
  • , J. Shepherd
  • , J. Simpson
  • , A. Srinivas-Murthy
  • , M. J. Stone
  • , A. Thomas
  • , J. Tredgold
  • , A. E. Ward
  • , K. Wartenberg
  • , E. Whitehall
  • , D. Williams
  •  & N. Zuraw

Contributions

Original study design by AEW. Formative feedback received from RATeS steering committee to modify design. All the authors were involved with the acquisition and subsequent analysis of data. Initial drafting of manuscript was performed by RATeS writing group. Draft manuscript was reviewed by the collaborative authors before generation of a final draft, which was approved by all the authors.

Corresponding author

Correspondence to Alex E. Ward.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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The members of RATeS Study Group are listed in acknowledgements.

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Ward, A.E., RATeS Study Group. RATeS (Re-Admissions in Trauma and Orthopaedic Surgery): a prospective regional service evaluation of complications and readmissions. Arch Orthop Trauma Surg 139, 1351–1360 (2019). https://doi.org/10.1007/s00402-019-03144-4

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  • DOI: https://doi.org/10.1007/s00402-019-03144-4

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