The Perioperative Surgical Home (PSH) is a physician-led, patient centered, rapid recovery care delivery model that includes multi-specialty care teams and cost-efficient use of resources developed to deliver patient centered value based care. The purpose of this study was to compare a group of patients undergoing primary total hip arthroplasty (THA) managed in the PSH model to a matched group managed in a more traditional fashion with respect to clinical outcomes, complications, and costs. We prospectively followed the first 180 THA patients from the PSH group, comparing them to a group matched for age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) Score, and Charlson Comorbidity Index (CCI) that was treated prior to implementation of the PSH. A combination of regional anesthesia and multi-modal pain control was used to minimize patient narcotic consumption. There was a rapid de-escalation of care post-operatively. Weekly multi disciplinary meetings were held where advanced discharge planning was discussed and we evaluated successes and areas of improvement of the prior week in an effort to continuously improve. We used Wilcoxon, Chi square, and multivariate regression analysis to compare the groups for length of stay (LOS), total direct cost (TDC), complications, 30-day readmissions, and discharge location.Background
Methods
The Perioperative Surgical Home (PSH) is a multi-disciplinary rapid recovery pathway aimed at transforming surgical care by delivering value and improving outcomes and patient satisfaction. Our institution developed a PSH pathway for total hip arthroplasty (THA) patients in March 2014. The Orthopaedic and Anesthesia Services co-managed the patients throughout the entire surgical process. Weekly meetings were held to discuss medical and social requirements for upcoming patients including disposition planning. All patients received day of surgery physical therapy, and anesthesia post-surgical pain control and medical co-management. We hypothesized that the PSH would provide enhanced care for THA patients. To our knowledge this is the first report on the PSH in a total joint population We prospectively followed 180 THA patients from the PSH group (SH) and compared them to a group matched for age, body mass index (BMI), American society of anesthesiologist score (ASA), and Charleson comorbidity index score (CCI) that were not involved in the PSH (NSH). We used Wilcoxon, Chi square, and multivariate analysis to compare the groups for length of stay (LOS), total direct cost (TDC), complications, readmissions at 30 days, and discharge disposition location.Background
Methods
Joint replacement surgery has been shown to be successful in post solid organ transplantation patients. However, complication rates, revision rates, and overall mortality can be higher in this population compared to patients who have not undergone solid organ transplantation. Many transplant patients have a decreased life expectancy. Therefore, literature suggests that joint replacement surgery be offered to qualifying patients early on when symptomatic. This study compares the outcomes of patients who have undergone solid organ transplantation as well as a joint replacement to patients that have only undergone joint replacement surgery. We retrospectively gathered 42 transplant (T) patients over a ten year period, 2003–2013, that underwent a liver (21) or kidney (21) transplant as well as primary total knee arthroplasty (TKA) (23) or total hip arthroplasty (THA) (19). We then gathered 42 non-transplant (NT) patients matched for procedure, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, and age adjusted Charlson co-morbidity index (ACCI) score who only underwent TKA or THA with no transplant. We used Chi-Square, T test, and multivariate analysis to compare the two groups with regard to number of complications (NOC), readmissions at 30 and 90 days post surgery, length of stay (LOS), number of intensive care unit (ICU) admissions, and total direct cost (TDC) per hospital stay.Background
Methods
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. 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 (Background
Methods
Complications following hip and knee arthroplasty can occur in any given patient. However, specific risk factors such as increased age, history of coexistent disease, and increased body mass index have been found to increase the risk of complications after such procedures. Complications often require prolonged hospital admission periods and added hospital resources which ultimately results in increased costs per hospital stay. However, if patients are pre-operatively risk stratified, and followed post-operatively for specific high risk medical issues, many complications may be avoided. By using a hospital standardised peri-operative risk stratification process, the cost per hospital stay for hip and knee arthroplasty may decrease. Overall hospital costs related to joint arthroplasty will be decreased by using a multi-disciplinary peri-operative risk stratification programme.Background:
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