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Hip Arthroscopy: Spatiotemporal Analysis in Three US States and Predictor of Revisit after a Procedure

André Pedrinelli*, Arnaldo José Hernandez, Leandro Ejnisman, Lorenzo Fagotti, Adriano Marques de Almeida and Tiago Lazzaretti Fernandes

Objective: The incidence of hip arthroscopy procedures has recently increased, current trends demonstrating a wide geographical variation and relatively similar functional outcomes among a wide age range. We aimed to evaluate spatio-temporal trends in state variation of hip arthroscopy procedures as well as the rate and determinants of 90-day hospital revisits.
Methods: This was a secondary spatiotemporal analysis of data on hip arthroscopy procedures from the Healthcare Cost and Utilization Project databases, including the State Inpatient Database (SID), the State Ambulatory Surgery Database and the State Emergency Department Database (SEDD) for Florida, Kentucky, and Maryland, spanning a total of six years (2009 - 2014). Revisit risk was only evaluated through Florida data.
Results: Out of 4,085 patients, the mean age was 40.7 years, 60.5% were female, 81.4% white, 77.7% had private insurance, and 96.5% were located in metropolitan areas. The average Charlson co-morbidity score was 0.11 (± 0.39), the Van Walraven score was 0.17 (± 1.51). Revisit rates progressively decreased during the study period, from 13.3% in 2009 to 6.2% in 2014 (p for trend < 0.001). Age >42 [OR: 2.13 (1.7, 2.69)] and a Charlson comorbidity score >0 [OR: 2.35 (1.73, 3.16)] were risk factors for a revisit. Paying mechanisms other than Medicare were protective. Most revisits (93.19%) occurred in the first 25 days after the procedure and the 90-day revisit rates for the State of Florida were centered on the major metropolitan areas such as West Palm Beach, Sarasota, Tampa, and Orlando. The incidence of hip arthroscopies increased in most parts of Florida, Kentucky, and Maryland over the study period.
Conclusion: Revisit rates may reflect the quality of care and highlight the need for improvement. Future registries should include patient factors like pre-operative function and social determinants of health that might influence outcomes and revisit rates.