Abstract
Background
Hospitalists have assumed an evolving role in the care of postsurgical orthopaedic patients. Literature has provided evidence to suggest improved outcomes in postsurgical hip fracture patients managed by hospitalists in nonteaching hospitals. However, the full impact of a hospitalist co-management model has not been fully investigated with regard to elective joint arthroplasty patients in a multispecialty teaching facility. We hypothesized that a hospitalist co-management model in the setting of a teaching hospital would lead to an increase in unnecessary medical workups for joint arthroplasty patients.
Methods
We retrospectively evaluated 2231 patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between May 2010 and January 2014 at one teaching facility, excluding any non-elective trauma patients. The patients were separated into a non-hospitalist (NH) cohort of 1062 patients that did not receive hospitalist co-management postsurgery, and a hospitalist (H) cohort of 1169 patients that received hospitalist co-management postsurgery. We used Student t test and significance of (P<0.05) to compare the following factors between the two patient cohorts: length of stay (LOS), readmission rates at 30 and 90 days postsurgery, number of diagnoses present on admission, and number of new diagnosis given during admission. We then compared the average number of diagnostic and laboratory studies performed per patient and the average cost per hospital stay between the two cohorts.
Results
We found no significant difference in LOS between the two groups. Readmission rates for THA patients in the H group increased significantly at 90 days postsurgery (P=0.012). We found no other significant differences in readmission rates at 30 or 90 days postsurgery. No significant difference was found between the two groups with regard to number of diagnoses present on admission. However, the H group experienced a significantly higher number of new diagnoses during the admission for both THA and TKA patients (P=0.03 andP=0.002 respectively). Finally we found no significant difference in the number of studies performed or the average cost per hospital stay between the two cohorts.
Conclusion
This study shows a significant increase in documented new diagnoses in postsurgical THA and TKA patients when using a hospitalist co-management model in a teaching hospital. However, LOS, and average cost per hospital stay did not show the same increase, and the readmission rate only increased significantly in THA patients in the H group at 90 days postsurgery. Therefore the H group gained a significant number of new diagnoses that seemed to remain subclinical during the postsurgical hospital stay. While hospitalists are trained to report all possible diagnoses for accurate billing purposes, some physician and hospital grading systems may view these new diagnoses as postsurgical complications resulting in penalties. Therefore, any potential benefit of a hospitalist co-management model for THAs and TKAs in a teaching hospital setting may be outweighed by the potential penalties associated with increased postsurgical subclinical diagnoses.
