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J Knee Surg 2023; 36(05): 459-464
DOI: 10.1055/s-0041-1736200
Original Article

Risk Factors for Readmission following Anterior Cruciate Ligament Reconstruction

Matthew J. Best 
1   Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Andrew B. Harris
2   Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
,
Majd Marrache
2   Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
,
Scott D. Martin
1   Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
John-Paul H. Rue
3   Department of Orthopaedic Surgery, Mercy Medical Center, Baltimore, Maryland
,
John H. Wilckens
2   Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
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Funding None.
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Abstract

The purpose of this study is to identify risk factors for readmission after anterior cruciate ligament (ACL) reconstruction and to determine costs associated with readmission. Using a private insurance claims' database, we identified patients who underwent ACL reconstruction from 2010 to 2015 using the International Classification of Diseases, Version 9 (ICD-9) and Current Procedural Terminology (CPT) codes. Univariate analysis was performed on demographic data, surgical characteristics, and comorbidities. Variables with p < 0.10 were added to a multivariate logistic regression model which was created to identify independent risk factors for all-cause readmission within 90 days postoperatively. Significance was considered at p < 0.05. Overall, 90,263 patients were included (average age: 29 ± 13 years, 44% female), and 1,066 (1.2%) of patients had a hospital readmission within 90 days following surgery. Risk factors for hospital readmission included cerebrovascular disease (odds ratio [OR] = 3.4, 95% confidence interval [CI]: 1.9, 6.2), diabetes mellitus (OR = 2.6, 95% CI: 1.9, 3.5), concomitant medial collateral ligament (MCL) or lateral collateral ligament (LCL) reconstruction (OR = 2.5, 95% CI: 1.9, 3.3), concomitant posterior cruciate ligament (PCL) reconstruction (OR = 2.2, 95% CI: 1.4, 3.3), age between 44 and 65 years (OR = 2.1, 95% CI: 1.6, 2.9), and depression (OR = 1.88, 95% CI: 1.49, 2.38, p < 0.001). Female sex was associated with decreased odds of 90-day hospital readmission (OR = 0.8, 95% CI: 0.7, 0.9). Each hospital readmission accounted for an estimated $17,841 (95% CI: $17,173, 18,509) in gross health care payments, and patients with readmissions had substantially higher 1-year cumulative health care costs. Readmission after ACL reconstruction was 1.2%. The strongest risk factors for 90-day readmission include cerebrovascular disease, diabetes mellitus, concomitant MCL/LCL reconstruction, concomitant PCL reconstruction, and age between 44 and 65 years. Readmission was associated with substantial health care costs.

Keywords

anterior cruciate ligament - ACL reconstruction - readmission - cost - risk factors

Note

The study was exempt from institutional review board approval.




Publication History

Received: 17 July 2020

Accepted: 18 August 2021

Article published online:
05 October 2021

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