The purpose of this study was to determine the rate of short-term complications after TEA and identify predictors of readmission and reoperation. We hypothesized that TEA performed for acute elbow trauma would have higher rates of 30-day readmission and reoperation than TEA for osteoarthritis.
Using the National Surgical Quality Improvement (NSQIP) database years 2011-2017, we identified patients undergoing TEA for fracture, osteoarthritis, or inflammatory arthritis. Patient demographics, comorbidities, reoperations and readmissions within thirty days of surgery were analyzed. Potential predictors of reoperation and readmission in the model include: age, sex, race, body mass index (BMI), diabetes, hypertension, chronic obstructive pulmonary disease (COPD), congestive heart failure, smoking, bleeding disorders, American Society of Anesthesiologists (ASA) classification, wound classification, operative time, and indication for surgery.
A total of 414 patients underwent TEA from 2011-2017. Of these patients, 40.6% underwent TEA for fracture, 37.0% for osteoarthritis, and 22.7% for inflammatory arthritis. The overall rate of unplanned readmission was 5.1% (21 patients). The rate of unplanned reoperations was 2.4% (10 patients). Infection was the most common reason for both unplanned readmission and reoperation. The rate of reoperation and readmission was not significantly associated with any of the three operative indications: fracture, osteoarthritis, or inflammatory arthritis. A multiple logistic regression analysis found increased BMI to be associated with lower odds of an unplanned readmission (OR=0.883, 95% CI: 0.798 to 0.963, p=0.0035), wound classification >3 associated with increased odds of an unplanned reoperation (OR=16.531, 95% CI: 1.300 to 167.960, p=0.0144) and total local complications (OR=17.587, 95% CI: 2.207 to 132.019, p=0.0057). Patients who were not functionally independent were more likely to experience local complications (OR=4.181, 95% CI: 0.983 to 15.664, p=0.0309) than functionally independent patients.
The 30-day unplanned reoperation rate after TEA was 2.4%, and the unplanned readmission rate was 5.1%. Low BMI was predictive of readmission. Wounds classified as contaminated or dirty were predictive of reoperation. Dependent functional status and contaminated wounds were predictive of local complications. The indication for TEA (fracture versus OA versus RA) was not found to be a risk factor for reoperation or readmission after TEA.
Copyright © 2020. Published by Elsevier Inc.