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Background: Septic arthritis is a severe condition with notable morbidity and mortality. Limited knowledge exists regarding factors influencing the readmission of septic arthritis in real-world scenarios.
Objectives: To explore 30-day readmission in patients with septic arthritis and identifying independent predictors associated with readmission using National Readmission Database (NRD).
Methods: In this retrospective study, the 2019 data from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project Nationwide Readmission Database were utilized. The primary focus was on determining the rate of readmission for all causes within 30 days post-discharge. Secondary objectives included assessing hospital-level metrics such as length of stay, total hospitalization charges, and costs. The identification of independent risk factors for readmission was carried out through Cox regression analysis.
Results: Of the 22,911 total index admissions, 851 resulted in readmissions. Males constituted the majority of index admissions at 64.8%, with a slightly higher readmission rate of 67.09%. The average age for index admissions was 58.1 years, decreasing to 54.1 years in readmitted patients. Insurance distribution showed a decline in readmissions among Medicare-insured patients (from 47.18% to 41.5%) and an increase among Medicaid-insured individuals (from 20.17% to 25.9%). Co-morbidities, such as chronic kidney disease (CKD), Hypertension, and Osteoarthritis, Alcohol Use, Liver Diseases, Thyroid Diseases, HIV, Other Connective Tissue disorders including RA, SLE, Sjogren’s Syndrome were prevalent in both cohorts. On identifying most common diagnosis for Septic Arthritis readmissions, top prevalent were Pyogenic Arthritis (M00.9) and Staphylococcal Arthritis (M00.062). Total Length of Stay for all readmissions in the year 2019 was 6683.75 days with total charges of $57,100,000$ ± $4,881,148. Independent Predictors for Readmissions includes age ([aOR] 0.986, p<0.0001), Medicaid insurance (aOR 1.46, p<0.001), rehab transfer (aOR 3.39, p<0.0001), smoking (aOR 1.46, p<0.0001), and connective tissue combined disorders (aOR 0.73, p<0.05).
Conclusion: Septic arthritis imposes a significant strain on hospital outcomes due to recurrent readmissions, leading to substantial healthcare utilization in the year 2019 alone. It is crucial to carefully examine independent predictors of readmissions associated in regards to septic Arthritis. Although it was a limitation that only 2019 data was used, but still smoking was a risk factor for recurrent admissions and readmissions was least in patients who had highest income bracket.
| Index Admissions | Readmissions | |
|---|---|---|
| Total Number | 22911 | 851 |
| Female | 35.13% | 32.90% |
| Male | 64.8% | 67.09% |
| Age | 58.1 years | 54.1year |
| Insurance | ||
| Medicare | 47.18% | 41.5% |
| Medicaid | 20.17% | 25.9% |
| Private | 26.25% | 25.8% |
| Uninsured | 6.37% | 6.25% |
| Charlson co-morbidity index | ||
| 1 | 43.65% | 45.33% |
| 2 | 26.58% | 26.27% |
| 3 | 29.75% | 28.38% |
| Income in Zip code | ||
| 1 - 47,999 | 31.33% | 31.87% |
| 48,000 - 60,999 | 27.85% | 26.98% |
| 61,000 - 81,999 | 24.66% | 26.37% |
| 82,000+ | 16.1% | 14.76% |
| Hospital Category | ||
| Large metropolitan areas with at least 1 million residents | 50.6% | 53.61% |
| Small metropolitan areas with less than 1 million residents | 40.54% | 38.81% |
| Micropolitan areas | 7.24% | 5.78% |
| Others | 1.59% | 1.78% |
| Hospital by Teaching Status | ||
| Metropolitan non-teaching | 16.98% | 14.36% |
| Metropolitan teaching | 74.17% | 78.06% |
| Non-metropolitan hospital | 8.83% | 7.56% |
| Rehab Transfer | 0.9% | 1.02% |
| Smoking | 44.01% | 50.96% |
| CHF | 12.4% | 10.74% |
| Pleuritis | 0.9% | 0.16% |
| Pericarditis | 4.07% | 3.40% |
| Osteoarthritis | 22.30% | 18.32% |
| Hypertension | 58.92% | 57.13% |
| Diabetes Mellitus | 31.17% | 32.04% |
| Obesity | 19.05% | 17.32% |
| CKD | 16.96% | 17.72% |
| Alcohol | 5.30% | 4.93% |
| Liver | 4.50% | 5.07% |
| Thyroid | 11.73% | 8.60% |
| Prednisone | 2.77% | 2.83% |
| Sepsis | 4.32% | 2.83% |
| Acute Renal Failure | 2.47% | 0.54% |
| HIV | 1.15% | 1.87% |
| RA | 5.66% | 3.79% |
| SLE | 0.76% | 1.85% |
| Rheumatoid Arthritis | 5.6% | 3.79% |
| Sjogren Syndrome | 0.71% | 1.31% |
| Gout | 11.46% | 8.51% |
| Connective Tissue combined | 18.08% | 13.81% |
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.