Editor’s Spotlight/Take 5: Hospital Readmissions After Treatment of Proximal Humerus Fractures: Is Arthroplasty Safer Than Open Reduction Internal Fixation?

U nplanned readmissions to the hospital after surgery are an unfortunate part of our practices as orthopaedic surgeons. We can screen our patients carefully, perform meticulous surgery, and take thoughtful steps to ensure that the patient has a safe place to go after discharge, but sometimes things fall apart. Government and private payers increasingly emphasize value, and preventable readmissions detract from it. More importantly, as professionals who provide care — and, more generally, as people who care — we find that unplanned readmissions sting. Because readmissions are uncommon, even a busy practice will not care for enough patients to allow a robust analysis of the causes of this important problem. Patient factors like infirmity and demography, hospital parameters including surgical volume, and provider choices such as what operations we use to manage particular diagnoses all will contribute to the readmission problem in confounding ways. To tease these apart requires some statistical heavy lifting, and that calls both for expertise and large sample sizes. As we have seen in this space recently [3, 4], surveys of large databases that ask the right questions can provide a way in. In this month’s CORR, a group from the University of California at San Francisco, led by Drs. Brian Feeley MD and Alan Zhang MD (Fig. 1), uses the State Inpatient Database from seven states [7] to identify factors independently associated with hospital readmission after treatment of proximal humerus fractures. While most of us may not treat patients with shoulder injuries, the take-home message from this study seems likely to be generalizable: Fully three-quarters of readmissions were caused by medical diagnoses. Surgical choices played in, but the effect size there was much smaller. In addition, and not surprisingly, several populations of patients appeared more vulnerable than others: Women, African American, patients in nursing homes, and patients cared for under the Medicaid plan all were more likely to be readmitted. Dr. Feeley’s group did some excellent work here, well worthy of our attention whether or not we treat shoulder fractures. While certainly Note from the Editor-In-Chief: In ‘‘Editor’s Spotlight,’’ one of our editors provides brief commentary on a paper we believe is especially important and worthy of general interest. Following the explanation of our choice, we present‘‘Take Five,’’ in which the editor goes behind the discovery with a oneon-one interview with an author of the article featured in ‘‘Editor’s Spotlight.’’ The author certifies that he, or any members of his immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or the Association of Bone and Joint Surgeons. This comment refers to the article available at DOI:10.1007/s11999-014-3613-y. S. S. Leopold MD (&) Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19013, USA e-mail: sleopold@clinOrthop.org Editor’s Spotlight/Take 5 Published online: 6 June 2014 The Association of Bone and Joint Surgeons1 2014