Adverse Events in Orthopaedics: Is XXXX More Risky? An Analysis of the NSQIP Data.

@entity1 @entity2045 @entity532 @entity1746 @entity130
OBJECTIVES: As our healthcare system moves toward bundling payments, orthopaedic @entity130 surgeons will be increasingly benchmarked on perioperative complications. We therefore sought to determine financial risks under bundled payments by identifying adverse event rates for (1) orthopaedic @entity130 @entity1 compared with general orthopaedic @entity1 and (2) based on anatomic region and (3) to identify @entity1 factors associated with complications. DESIGN: Prospective. SETTING: Multicenter. @entity1 / @entity1 : A total of 146,773 orthopaedic @entity1 (22,361 @entity130 ) from 2005 to 2011 NSQIP data were identified. INTERVENTIONS: Minor and major adverse events, demographics, surgical variables, and @entity1 comorbidities were collected. MAIN OUTCOME MEASUREMENTS: Multivariate regressions determined significant risk factors for the development of complications. RESULTS: The @entity532 rate in the @entity130 group was 11.4% (2554/22,361) versus 4.1% (5137/124,412) in the general orthopaedic group (P = 0.001). When controlling for all variables, @entity130 was a risk factor for developing complications [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.57-1.81]. After controlling for several @entity1 factors, hip and pelvis @entity1 were 4 times more likely to develop any perioperative @entity532 than @entity2045 @entity1 (OR: 3.79, 95% CI: 3.01-4.79, P = 0.01). Lower @entity1746 @entity1 are 3 times more likely to develop any @entity532 versus @entity2045 @entity1 (OR: 2.82, 95% CI: 2.30-3.46, P = 0.01). CONCLUSIONS: Our study is the first to show that orthopaedic @entity130 @entity1 are 2 times more likely than general orthopaedic @entity1 to sustain complications, despite controlling for identical risk factors. There is also an alarming difference in @entity532 rates among anatomic regions. Orthopaedic @entity130 surgeons will face increased financial risk with bundled payments. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
