Do In-Hospital Rothman Index Scores Predict Postdischarge Adverse Events and Discharge Location After Total Knee Arthroplasty?

Andrew D. Kleven*, Austin H. Middleton, Ziynet Nesibe Kesimoglu, Isaac C. Slagel, Ashley E. Creager, Ryan Hanson, Serdar Bozdag, Adam I. Edelstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There have been efforts to reduce adverse events and unplanned readmissions after total joint arthroplasty. The Rothman Index (RI) is a real-time, composite measure of medical acuity for hospitalized patients. We aimed to examine the association among in-hospital RI scores and complications, readmissions, and discharge location after total knee arthroplasty (TKA). We hypothesized that RI scores could be used to predict the outcomes of interest. Methods: This is a retrospective study of an institutional database of elective, primary TKA from July 2018 until December 2019. Complications and readmissions were defined per Centers for Medicare and Medicaid Services. Analysis included multivariate regression, computation of the area under the curve (AUC), and the Youden Index to set RI thresholds. Results: The study cohort's (n = 957) complications (2.4%), readmissions (3.6%), and nonhome discharge (13.7%) were reported. All RI metrics (minimum, maximum, last, mean, range, 25th%, and 75th%) were significantly associated with increased odds of readmission and home discharge (all P < .05). RI scores were not significantly associated with complications. The optimal RI thresholds for increased risk of readmission were last ≤ 71 (AUC = 0.65), mean ≤ 67 (AUC = 0.66), or maximum ≤ 80 (AUC = 0.63). The optimal RI thresholds for increased risk of home discharge were minimum ≥ 53 (AUC = 0.65), mean ≥ 69 (AUC = 0.65), or maximum ≥ 81 (AUC = 0.60). Conclusion: RI values may be used to predict readmission or home discharge after TKA.

Original languageEnglish (US)
Pages (from-to)668-673
Number of pages6
JournalJournal of Arthroplasty
Volume37
Issue number4
DOIs
StatePublished - Apr 2022
Externally publishedYes

Keywords

  • Rothman Index
  • discharge planning
  • postoperative outcomes
  • readmission
  • total knee arthroplasty

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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