Dundon et al reported a Readmission Risk Assessment Tool (RRAT) for use in patients undergoing total joint arthroplasty. This can help to identify a patient at greater risk of 30-day readmission. The authors are from the Orthopedic Institute of New Jersey, Nova Southeastern University and Hackensack University in New Jersey.
Patient selection: total joint arthroplasty
Parameters:
(1) colonization with Staphylococcus aureus
(2) tobacco smoking
(3) body mass index (BMI) as measure of obesity
(4) cardiovascular disease
(5) venous thromboembolic disease
(6) neurocognitive, psychological, and behavioral problems
(7) physical deconditioning
(8) diabetes
Parameter
Finding
Points
Staph aureus colonization
no
0
yes
3
tobacco use
no
0
yes
1
body mass index
< 30 kg per sq meter
0
30 to 34 kg per sq m
1
35 to 39.9 kg per sq m
2
>= 40 kg per sq m
3
cardiovascular disease
no
0
yes
1
venous thromboembolic disease
no risk factors
0
risk factors present
1
history of PE or DVT
2
neurocognition, etc
no deficits
0
defects such as dementia
1
depression (PHQ-9 >7)
1
alcohol or substance dependent
2
physical deconditioning
normal
0
comorbidities affect physical function and ambulation
1
non-ambulatory or needs help with transfers
2
diabetes
none
0
well-controlled
1
not well controlled (HgbA1c > 8%)
2
fasting blood glucose > 180 mg/dL
3
Interpretation:
• minimum score: 0
• maximum score: 17
• A score >= 4 identifies a patient who may benefit from interventions before and after surgery to reduce readmission.
Score
Readmission Rate
< 4
2.3%
4 to 6
4.3%
> 6
14%
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