Timing of Readmissions After Elective Total Hip and Knee Arthroplasty: Does a 30-Day All-Cause Rate Capture Surgically Relevant Readmissions?

Background: The 30-day all-cause readmission rate is a widely used metric of hospital performance. However, there is lack of clarity as to whether 30 days is an appropriate time frame following surgical procedures. Our aim is to determine whether a 90-day time window is superior to a 30-day time window in capturing surgically relevant readmissions after total hip arthroplasty (THA) and total knee arthroplasty (TKA).

The Validity of All-Cause 30-Day Readmission Rate as a Hospital Performance Metric After Primary Total Hip and Knee Arthroplasty: A Systematic Review.

Background: Risk-adjusted all-cause 30-day readmission rate (ACRR) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) is currently used as a metric of hospital performance as part of the Hospital Readmissions Reduction Program. However, the extent to which it is determined by hospital-related factors and is therefore a fair method of determining reimbursement remains unclear.

Methods: Our aim was to systematically review the available literature pertaining to whether ACRR is a valid metric of hospital performance after elective primary THA or TKA as determined by (1) its association with other performance metrics, (2) the extent to which variation in ACRR can be explained by between-hospital variation, and (3) the relative importance of hospital-related versus surgeon- or patient-related factors in determining ACRR.

Risk factors for early revision after total hip and knee arthroplasty: National observational study from a surgeon and population perspective.

Aims: To identify predictors of early revision (within 3 years of the index operation) for hip and knee replacement (HR, KR) from both surgeon and population perspectives.

Patients And Methods: Hierarchical logistic regression on national administrative data for England for index procedures between April 2009 and March 2014.

Results: There were 315,273 index HR procedures and 374,530 index KR procedures for analysis.

The weekend effect: does hospital mortality differ by day of the week? A systematic review and meta-analysis.

Background: The concept of a weekend effect, poorer outcomes for patients admitted to hospitals at the weekend is not new, but is the focus of debate in England. Many studies have been published which consider outcomes for patients on admitted at the weekend. This systematic review and meta-analysis aims to estimate the effect of weekend admission on mortality in UK hospitals.

Should Emergency Department Attendances be Used With or Instead of Readmission Rates as a Performance Metric?: Comparison of Statistical Properties Using National Data.

Background: Hospital readmissions are common and are viewed as unfavorable. They are commonly used as a measure of quality of care and, in the United States and England, are associated with financial penalties. Readmissions are not the only possible return-to-acute-care metric; patients may also attend emergency departments (EDs).

Secondary analysis of hospital patient experience scores across England's National Health Service - How much has improved since 2005?

Objective: To examine trends in patient experience and consistency between hospital trusts and settings.

Methods: Observational study of publicly available patient experience surveys of three hospital settings (inpatients (IP), accident and emergency (A&E) and outpatients (OP)) of 130 acute NHS hospital trusts in England between 2004/05 and 2014/15.

Results: Overall patient experience has been good, showing modest improvements over time across the three hospital settings.

Comparative epidemiology of Clostridium difficile infection: England and the USA.

Objective: To examine whether there is an epidemiological difference between Clostridium difficile infection (CDI) inpatient populations in England and the United States.

Design: A cross-sectional study.

Setting: National administrative inpatient discharge data from England (Hospital Episode Statistics) and the USA (National Inpatient Sample) in 2012.

Factors Associated With 30-Day Readmission After Primary Total Hip Arthroplasty: Analysis of 514 455 Procedures in the UK National Health Service.

Importance: Thirty-day readmission to hospital after total hip arthroplasty (THA) has significant direct costs and is used as a marker of hospital performance. All-cause readmission is the only metric in current use, and risk factors for surgical readmission and those resulting in return to theater (RTT) are poorly understood.

Objective: To determine whether patient-related predictors of all-cause, surgical, and RTT readmission after THA differ and which predictors are most significant.

Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling.

Heart failure (HF) is a common, serious chronic condition with high morbidity, hospitalisation and mortality. The healthcare systems of England and the northern Italian region of Lombardy share important similarities and have comprehensive hospital administrative databases linked to the death register. We used them to compare admission for HF and mortality for patients between 2006 and 2012 (n = 37,185 for Lombardy, 234,719 for England) with multistate models.

Vocal palsy increases the risk of lower respiratory tract infection in low-risk, low-morbidity patients undergoing thyroidectomy for benign disease: A big data analysis.

Objectives: Thyroidectomy is the commonest operation that places normally functioning laryngeal nerves at risk of injury. Vocal palsy is a major risk factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

Impact of the method and success of pharyngeal reconstruction on the outcome of treating laryngeal and hypopharyngeal cancers with pharyngolaryngectomy: A national analysis.

Background: Surgical treatment of cancers that arise from or invade the hypopharynx presents major reconstructive challenges. Reconstructive failure exposes the airway and neck vessels to digestive contents.

Methods: We performed a national N = near-all analysis of the administrative dataset to identify pharyngolaryngectomies in England between 2002 and 2012.

Bed utilisation and increased risk of infections in acute hospitals in England in 2013/2014.

Background: The study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for infections (CDI) in acute hospitals in England.

Method: A retrospective analysis was carried out on reported data from the English National Health Service (NHS) for the financial year 2013/2014. Reported rates of CDI were used as a proxy for hospital infection rates in acute NHS hospital trusts.

A national analysis of trends, outcomes and volume-outcome relationships in thyroid surgery.

Objectives: Thyroid conditions are common, and their incidence is increasing. Surgery is the mainstay treatment for many thyroid conditions, and understanding its utilisation trends and morbidity is central to improving patient care.

Design: An N = near-all analysis of the English administrative dataset to identify trends in thyroid surgery specialisation, volume-outcome relationships, and the incidence and risk factors for short- and long-term morbidity.

Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study.

Objectives: To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2 weeks of hospital discharge, as now recommended by guidelines.

Design: Observational study of national administrative data.

Investigating Adverse Event Free Admissions in Medicare Inpatients as a Patient Safety Indicator.

Objective: To investigate adverse event free admissions as a potential, patient-centered indicator aligned directly with the goal of patient safety-freedom from harm.

Background: Preventable adverse event rates in healthcare could be further reduced. These are generally measured separately, one adverse event at a time.

A stratified analysis of the perioperative outcome of 17623 patients undergoing major head and neck cancer surgery in England over 10 years: Towards an Informatics-based Outcomes Surveillance Framework.

Objectives: To perform a national analysis of the perioperative outcome of major head and neck cancer surgery to develop a stratification strategy and outcomes assessment framework using hospital administrative data.

Design: A Hospital Episode Statistics N = near-all analysis.

Settings: The English National Health Service.

Stroke Severity Is a Crucial Predictor of Outcome: An International Prospective Validation Study.

Background: Stroke is among the leading causes of morbidity and mortality worldwide. Without reliable prediction models and outcome measurements, comparison of care systems is impossible. We analyzed prospectively collected data from 4 countries to explore the importance of stroke severity in outcome prediction.

Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England.

Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.

Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.

The effect of new oral anticoagulants and extended thromboprophylaxis policy on hip and knee arthroplasty outcomes: observational study.

The efficacy and safety of the new oral anticoagulants (NOAC) and the benefits of extended duration thromboprophylaxis following hip and knee replacements remain uncertain. This observational study describes the relations between thromboprophylaxis policies following hip and knee replacements across England's NHS and patient outcomes between January 2008 and December 2011. From the national administrative database, we analyzed mortality, thromboembolic complications, emergency readmission, and bleeding rates for 201,418 hip and 230,282 knee replacements.

Role of reconstructive surgery in the management of head and neck cancer: a national outcomes analysis of 11,841 reconstructions.

Background: The quality of head and neck cancer reconstruction in England is not known. Hospital administrative data provides details of treatment within the English National Health Service and may be used for national outcomes analysis.

Methods: An algorithm for identifying head and neck surgery with flap-based reconstruction from administrative data was constructed and validated against information from three cancer units.

Return to theatre for elective hip and knee replacements: what is the relative importance of patient factors, surgeon and hospital?

The aim of this study was to define return to theatre (RTT) rates for elective hip and knee replacement (HR and KR), to describe the predictors and to show the variations in risk-adjusted rates by surgical team and hospital using national English hospital administrative data. We examined information on 260 206 HRs and 315 249 KRs undertaken between April 2007 and March 2012. The 90-day RTT rates were 2.

Classifying hospitals as mortality outliers: logistic versus hierarchical logistic models.

The use of hierarchical logistic regression for provider profiling has been recommended due to the clustering of patients within hospitals, but has some associated difficulties. We assess changes in hospital outlier status based on standard logistic versus hierarchical logistic modelling of mortality. The study population consisted of all patients admitted to acute, non-specialist hospitals in England between 2007 and 2011 with a primary diagnosis of acute myocardial infarction, acute cerebrovascular disease or fracture of neck of femur or a primary procedure of coronary artery bypass graft or repair of abdominal aortic aneurysm.

Global comparators project: international comparison of hospital outcomes using administrative data.

Objective: To produce comparable risk-adjusted outcome rates for an international sample of hospitals in a collaborative project to share outcomes and learning.

Data Sources: Administrative data varying in scope, format, and coding systems were pooled from each participating hospital for the years 2005-2010.

Study Design: Following reconciliation of the different coding systems in the various countries, in-hospital mortality, unplanned readmission within 30 days, and "prolonged" hospital stay (>75th percentile) were risk-adjusted via logistic regression.

Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics.

Objectives: To assess the association between mortality and the day of elective surgical procedure.

Design: Retrospective analysis of national hospital administrative data.

Setting: All acute and specialist English hospitals carrying out elective surgery over three financial years, from 2008-09 to 2010-11.