Established and Novel Risk Factors for 30-Day Readmission Following Total Knee Arthroplasty: A Modified Delphi and Focus Group Study to Identify Clinically Important Predictors

Daniel Gould; Michelle Dowsey; Tim Spelman; James Bailey; Samantha Bunzli; Siddharth Rele; Peter Choong

doi:10.3390/jcm12030747

Established and Novel Risk Factors for 30-Day Readmission Following Total Knee Arthroplasty: A Modified Delphi and Focus Group Study to Identify Clinically Important Predictors

J Clin Med. 2023 Jan 17;12(3):747. doi: 10.3390/jcm12030747.

Authors

Daniel Gould¹, Michelle Dowsey^{1

2}, Tim Spelman¹, James Bailey³, Samantha Bunzli^{4

5}, Siddharth Rele¹, Peter Choong^{1

2}

Affiliations

¹ Department of Surgery, University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.
² Department of Orthopaedics, St. Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.
³ School of Computing and Information Systems, University of Melbourne, Melbourne, VIC 3010, Australia.
⁴ Nathan Campus, School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia.
⁵ Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia.

Abstract

Thirty-day readmission following total knee arthroplasty (TKA) is an important outcome influencing the quality of patient care and health system efficiency. The aims of this study were (1) to ascertain the clinical importance of established risk factors for 30-day readmission risk and give clinicians the opportunity to suggest and discuss novel risk factors and (2) to evaluate consensus on the importance of these risk factors. This study was conducted in two stages: a modified Delphi survey followed by a focus group. Orthopaedic surgeons and anaesthetists involved in the care of TKA patients completed an anonymous survey to judge the clinical importance of risk factors selected from a systematic review and meta-analysis and to suggest other clinically meaningful risk factors, which were then discussed in a focus group designed using elements of nominal group technique. Eleven risk factors received a majority (≥50%) vote of high importance in the Delphi survey overall, and six risk factors received a majority vote of high importance in the focus group overall. Lack of consensus highlighted the fact that this is a highly complex problem which is challenging to predict and which depends heavily on risk factors which may be open to interpretation, difficult to capture, and dependent upon personal clinical experience, which must be tailored to the individual patient.

Keywords: Delphi survey; arthroplasty; clinical; focus group; knee; readmission; risk factors.

Grants and funding

No funding was received directly for this study. D.G., S.R., S.B. and T.S. received no funding. P.C. had the following funding sources to declare: royalties from Johnson and Johnson, a consultancy with Johnson & Johnson, and a consultancy with the Stryker Corporation (paid personally); The Australian National Health & Medical Research Council Practitioner Fellowship (paid to the institution), HCF Foundation, BUPA Foundation, St. Vincents Health Australia, Australian Research Council (grant support provided to the institution for research unrelated to the current manuscript); The Axcelda cartilage regeneration project: patent applied for the device, the composition of matter, and the process (institution and personally). M.D. had the following funding sources to declare: National Health and Medical Research Council, HCF Foundation, BUPA Foundation, St. Vincents Health Australia, Australian Research Council (grant support provided to my institution for research unrelated to the current manuscript)—paid to the institution. J.B. had the following funding sources to declare: The National Health and Medical Research Council and Australian Research Council (grant support provided to my institution for research unrelated to the current manuscript); patent application no PCT/AU2020/050926 titled “System and Method for Audio Annotation:” Khan, Velloso and Bailey.