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Background: The Centers for Medicare & Medicaid Services currently incentivizes hospitals to reduce postdischarge adverse events such as unplanned hospital readmissions for patients who underwent total joint arthroplasty (TJA). This study aimed to predict 90-day TJA readmissions from our comprehensive electronic health record data and routinely collected patient-reported outcome measures.
Methods: We retrospectively queried all TJA-related readmissions in our tertiary care center between 2016 and 2019. A total of 104-episode care characteristics and preoperative patient-reported outcome measures were used to develop several machine learning models for prediction performance evaluation and comparison. For interpretability, a logistic regression model was built to investigate the statistical significance, magnitudes, and directions of associations between risk factors and readmission.
Results: Given the significant imbalanced outcome (5.8% of patients were readmitted), our models robustly predicted the outcome, yielding areas under the receiver operating characteristic curves over 0.8, recalls over 0.5, and precisions over 0.5. In addition, the logistic regression model identified risk factors predicting readmission: diabetes, preadmission medication prescriptions (ie, nonsteroidal anti-inflammatory drug, corticosteroid, and narcotic), discharge to a skilled nursing facility, and postdischarge care behaviors within 90 days. Notably, low self-reported confidence to carry out social activities accurately predicted readmission.
Conclusions: A machine learning model can help identify patients who are at substantially increased risk of a readmission after TJA. This finding may allow for health-care providers to increase resources targeting these patients. In addition, a poor response to the "social activities" question may be a useful indicator that predicts a significant increased risk of readmission after TJA.
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http://dx.doi.org/10.1016/j.artd.2023.101308 | DOI Listing |
Front Oncol
December 2024
Research Group Integrative Medicine, Department of General and Visceral Surgery, University Hospital Ulm, Ulm, Germany.
Background: Integrative Oncology (IO) - the use of lifestyle modifications, mind-body practices and natural products in oncology - is increasingly asked for by patients. The evidence base of IO is growing and IO measures are included in national guidelines. Still, many questions about IO remain unanswered or still show a poor evidence base.
View Article and Find Full Text PDFJ Clin Orthop Trauma
January 2025
St John of God Subiaco and Midland Hospitals, Subiaco, 6008, WA, Australia.
Introduction: Total knee arthroplasty (TKA) in severe varus deformity still remains a challenge. Alternative alignment TKA aims to improve outcomes and satisfaction. The purpose of this study is to report on the outcomes of a functionally aligned TKA in severe varus deformity.
View Article and Find Full Text PDFJBJS Essent Surg Tech
December 2024
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Background: For complete disruption of the posterolateral corner (PLC) structures, operative treatment is most commonly advocated, as nonoperative treatment has higher rates of persistent lateral laxity and posttraumatic arthritis. Some studies have shown that acute direct repair results in revision rates upwards of 37% to 40% compared with 6% to 9% for initial reconstruction. In a recent study assessing the outcomes of acute repair of PLC avulsion injuries with 2 to 7 years of follow-up, patients with adequate tissue were shown to have a much lower failure rate than previously documented.
View Article and Find Full Text PDFNeurol Clin Pract
February 2025
University of Rochester School of Medicine and Dentistry (JS, AV); Center for Health and Technology (CHeT) (JS, JW, AV, SJR, CE, AA, CZ, CRH), University of Rochester; University of Utah Spencer Fox Eccles School of Medicine (SJR); Des Moines University College of Osteopathic Medicine (AA); Department of Biostatistics and Neurology (ND), University of Rochester; Alzheimer's Disease Care, Research and Education Program (AD-CARE) (AM, SS-S, EJS), University of Rochester; and Department of Neurology (CRH), University of Rochester.
Background And Objectives: In preparation for future clinical trials involving individuals with Alzheimer disease (AD), mild cognitive impairment (MCI), and dementia, it is important to ascertain the widespread impact of symptoms from the direct perspectives of patients and caregivers. In this study, we performed cross-sectional surveys using large-scale patient and caregiver data to identify the prevalence and average impact of symptoms and symptomatic themes experienced by adults with AD, MCI, and dementia. Subsequent analyses were used to determine which demographic and disease-specific factors are associated with more severe disease.
View Article and Find Full Text PDFHeliyon
December 2024
Harvard University, Cambridge, MA, United States.
The growing prevalence of coronary artery diseases in the US corresponds to the increasing use of minimally invasive techniques that require coronary stents. Although extensive research is available on the perioperative outcomes of the 3 stent options - bare-metal stents (BMS), drug-eluting stents (DES), and bioresorbable drug-eluting stents (BVS), a knowledge gap exists in the longitudinal monitoring of patient outcomes due to device-related causes. Therefore, our study examines the device-related patient outcome and the relative performance for BMS, DES, and BVS.
View Article and Find Full Text PDFEnter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!