The European population is consistently getting older and this trend is expected to continue with fastest rise seen in those over 85 years old. As a consequence there will be more nonagenarians (over 90 years old) having lower limb arthroplasty. To compare the length of stay, readmission and one year mortality between nonagenarians and people aged between 70 to 80 years after having lower limb arthroplasty.Abstract
Background
Objectives
Over 35% of surgeons in the United States, and 10% in Canada use the direct anterior approach for primary total hip arthroplasty (THA). Some of the key barriers in its wider adoption are the learning curve and associated increased risk of adverse events. The purpose of this study was to determine the adoption rate as well as 90-day re-admission and adverse event of the anterior approach in a community-based hospital. From December 2015 to August 2018, two laterally based approach senior orthopaedic surgeons with over 20 years of practice performed 319 primary total hip replacements, with 164 being done through the anterior approach and 155 through the lateral approach. All but 8 of the anterior approaches were done on a regular operating table.Background
Methods
The burden of hospital length of stay (LOS) and readmissions for total hip arthroplasty (THA) patients has resulted in great scrutiny. The purpose of this study was to determine our patients' LOS and hospital readmissions over the past 7 years. The second purpose was to determine what comorbidities affected the LOS and readmissions of 1440 THA patients. 1440 THA patients were retrospectively reviewed. The group included 622 males, 818 females. The average age of the cohort was 60 years (12 to 94 years). Ninety-day hospital readmissions were measured for the patients. Fisher's exact test, independent Sample The LOS decreased over the time of the study (p=0.02), however; readmissions remained constant at approximately 6% (p=0.73). The mean LOS for patients not readmitted was significantly shorter than for those readmitted (3.2 vs. 4.4 days; p=0.0003). Comorbidities associated with a longer hospital stay included diabetes (p=0.0052), hypertension (p=0.04), coronary artery disease (p=0.0034), congestive heart failure (p=0.0012), peripheral vascular disease (p=0.015), chronic obstructive pulmonary disease (p=0.016), renal disease (p=0.009), and mental illness (p=0.03). Increased body mass index (BMI) was not associated with a significant increase in LOS (r=0.01, p=0.83). Increased readmission rates were associated with comorbidities including hypertension (p=<0.0001), coronary artery disease (p=<0.0001), congestive heart failure (p=0.0007), peripheral vascular disease (p=<0.0001), chronic obstructive pulmonary disease (p=0.003), asthma (p=0.0128), renal disease (p=0.0001), and mental illness (p=0.0147). Obesity was not associated with increased readmission rates until the patients were morbidly obese (>40 BMI; p=0.03). Although the LOS decreased over the time of the study, this did not result in an adverse increase in readmission rates. Several comorbidities including hypertension, coronary artery disease, congestive heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, and mental illness were all associated with both a longer LOS and an increase in readmission rates. Asthma was associated with increased readmission rates only and diabetes was associated with an increased LOS only. BMI was not associated with readmission rates unless the BMI exceeded 40 and had no significant effect on LOS at any BMI level.
Following a total hip arthroplasty (THA), early hospital readmission rates of 3–8% are considered as ‘acceptable’ in terms of medical care cost policies. Surprisingly, the impact of readmissions on mortality has not been priorly portrayed. Therefore, we aimed to analyse the mortality of unplanned readmissions after primary THA at a high-volume Argentinian center. We prospectively analysed 90-day readmissions of 815 unilateral, elective THA patients operated between 2010–2014 whose medical insurance was the one offered by our institution. Mean follow-up was 51 months (range, 37–84). Median age was 69 (IQR, 62–77). We stratified our sample into readmitted and non-readmitted cohorts. Through a Cox proportional hazard model, we compared demographic characteristics, clinical comorbidities, surgical outcomes and laboratory values between both groups in order to determine association with mortality. We found 37 (4.53%) readmissions at a median time of 40.44 days (IQR: 17.46–60.69). Factors associated with readmission were: hospital stay (p=0.00); surgical time (p=0.01); chronic renal insufficiency (p=0.03); ASA class 4 (p=0.00); morbid obesity (p=0.006); diabetes (p=0.04) and a high Charlson Index (p=0.00). Overall mortality rate of the series was 3.31% (27/815). Median time to mortality was 455.5 days (IQR: 297.58–1170.65). One-third (11/37) of the readmitted patients died, being sepsis non-related to the THA the most common cause of death. After adjusting for confounders, 90-day readmissions remained associated with mortality with an adjusted HR of 3.14 (CI95%: 1.05–9.36, p=0.04). Unplanned readmissions were an independent risk factor for future mortality, increasing 3 times the risk of a decease eventuality.
In surgeon controlled bundled payment and service models, the goal is to reduce cost but preserve quality. The surgeon not only takes on risk for the surgery, but all costs during 90 days after the procedure. If savings are achieved over a previous target price, the surgeon can receive a monetary bonus. The surgeon is placed in a position to optimize the patients preoperatively to minimize expensive postoperative readmissions in a high risk population. Traditionally, surgeons request that primary care providers medically clear the patient for surgery with cardiology consultation at their discretion, and without dictating specific testing. Our participation in the Bundled Payments for Care Improvement (BPCI) program for total hip and knee replacement surgeries since 1/1/15 has demonstrated a significant number of patients having costly readmissions for cardiac events. To determine the medical effectiveness and cost savings of instituting a new innovative cardiac screening program Background
Objective
This study aims to identify the incidence and factors influencing readmissions following scoliosis surgery over a period of 19 years. A search was conducted in the hospital database between 7th January 1992 and 29th December 2010. 73 diagnostic codes were used to identify all scoliosis patients within this period. Repetitions of hospital codes were identified and these represent readmission episodes. Each readmission episode was manually classified using hospital diagnostic/procedural codes, clinic letters, or radiographs. The average costs of the implants used were calculated using the hospital costing database.PURPOSE
METHODS
CMS is now publicly reporting 30-day readmission rates following total joint replacement (TJR) by hospital and is planning the collection of patient-reported function and pain after TJR. Nationally, 5% of patients are readmitted to the hospital after TJR for both medical and orthopedic-related issues. However, the relationship between readmission and functional gain and pain relief after TJR has not been evaluated. Clinical data on 2990 CMS patients from over 150 surgeons practicing in 22 US states who elected primary unilateral TJR in 2011–2012 were identified. Measures include pre-operative demographics, BMI, medical and musculoskeletal comorbidities, pain and function (KOOS/HOOS; SF36) and 6 month post-TJR pain and function. Data were merged with CMS claims to verify 30-day readmissions. Descriptive statistics and multivariate models adjusted for covariates and clustering within site were performed.Introduction
Methods
In the era of alternative payment models, providers and healthcare systems must understand the implications of potentially-modifiable risk factors on outcomes that affect overall cost. High BMI is associated with increased rates of complications (infection, loosening) in primary total hip arthroplasty (THA), but less is known about its impact on cost. In addition, the effects of low BMI on outcomes and cost are less-understood. This study sought to evaluate the relationship between BMI and length of stay (LOS), complications, thirty-day readmissions, inpatient cost, and need for post-acute services. A retrospective database analysis was conducted of 34,679 primary THAs performed between 2013–2017 in 29 hospitals in an integrated health system. Patient BMI was compared with operative time, LOS, complication rate, thirty-day readmission rate, inpatient cost, and post discharge disposition. Logistic regression was performed treating complications and readmission as outcomes and controlling for age.Introduction
Methods
This clinical study aims to establish the rate of operative inadvertent hypothermia (IH) in elderly hip fracture patients (>65 years old). We postulate that differences exist in risk factors and hypothesised poorer outcomes in patients with IH. A single centre, retrospective study of 929 hip fracture patients managed operatively between June 2015 and July 2017 was conducted. Patients’ demographic, anaesthetic and surgical variables were analysed together with outcomes for length of stay (LOS), 30-day re-admissions, and 30-day mortality.Background
Methods
The Bundled Payments for Care Improvement (BPCI) was developed by the US Center for Medicare and Medicaid (CMS) to evaluate a payment and service delivery model to reduce cost but preserve quality. 90 day postoperative expenditures are reconciled against a target price, allowing for a monetary bonus to the provider if savings were achieved. The surgeon is placed in a position to optimize the patients preoperatively to minimize expensive postoperative cardiovascular readmissions in a high risk population. Traditionally, surgeons request that primary care providers medically clear the patient for surgery with or without additional cardiology consultation, without dictating specific testing. Typical screening includes an EKG, occasionally an echocardiogram and nuclear stress test, and rarely a cardiac catheterization. Our participation in the BPCI program for total hip and knee replacement surgeries since 1/1/15 has demonstrated a significant number of patients having readmissions for cardiac events. To determine the medical effectiveness and cost savings of instituting a new innovative cardiac screening program Background
Objective
The purpose of this study is to compare 90-day costs and outcomes for primary total hip arthroplasty (THA) patients between a non-obese (BMI 18.5–24.9) versus overweight (25–29.9), obese (30–34.9), severely-obese (35–39.9), morbidly-obese (40–44.9), and super-obese (45+) cohorts. We conducted a retrospective review of a prospective institutional database of primary THA patients from 2006–2013, including patients with a minimum of three-year follow-up. Thirty-three super-obese patients were identified, and the other five cohorts were randomly selected in a 2:1 ratio (total n = 363). Demographics, 90-day outcomes (costs, reoperations, and readmissions), and outcomes after three years (revisions and change scores for SF12, HHS, and WOMAC) were collected. Costs were determined using unit costs from our institutional administrative data for all in-hospital resource utilization. Comparisons between the non-obese and other groups were made with Kruskal-Wallis tests for non-normal data and chi-square and Fisher's exact test for categorical data. The 90-day costs in the morbidly-obese ($13,134 ± 7,250 mean ± standard deviation, p <0.01) and super-obese ($15,604 ± 6,783, p <0.01) cohorts were statistically significantly greater than the non-obese cohorts ($10,315 ± 1,848). Only the super-obese cohort had statistically greater 90-day reoperation and readmission rates than the non-obese cohort (18.2% vs 0%, p <0.01 and 21.2% vs 4.5%, p=0.02, respectively). In addition, reoperations and septic revisions after 3 years were greater in the super-obese cohort compared to the non-obese cohort 21.2% vs 3.0% (p = 0.01), and 18.2% vs 1.5% (p= 0.01), respectively. There were no other statistical differences between the other cohorts with the non-obese cohort at 90-days or after 3 years. Improvements in SF12, HHS, and WOMAC were comparable in all cohorts. The 90-day costs of a primary total hip arthroplasty for morbidly-obese (BMI 40–44.9) and super-obese (BMI>45) are significantly greater than for non-obese patients, yet these patients have comparable improvements in outcome scores. Health care policies, when based purely on the economic impact of health care delivery, may place morbidly-obese and super-obese patients at risk of losing arthroplasty care, thereby denying them access to the comparable quality of life improvements.
Rapid recovery protocols (RRP) for joint replacements have been shown to improve efficiency, reduce costs, and minimize adverse outcomes in academic health systems. The purpose of this study is to evaluate if RRP can be safely implemented in a community health system for total knee arthroplasty. This study used a retrospective cohort of 3,608 patients who underwent primary unilateral total knee arthroplasty from January 1, 2013 to December 31, 2014. 60 Patients were excluded because data or surgery could not be verified: BMI less than 18.5 or greater than 60 kg/m∘2 or if the surgical time was less than 45 seconds or greater than 180 minutes, and bilateral surgery. Data was obtained from querying the health system's inpatient database containing information for all joint replacements within the system. Patients were compared in two groups: those who received a RRP after surgery versus those who received traditional post-op care. The main outcome measure was all-cause 30-day readmissions. Multivariate logistic regression was used to calculate the odds for all-cause 30-day readmission for patients who received RRP versus traditional care when controlling for age, gender, race, insurance status (Medicare versus no Medicare), obesity, diabetes, renal disease, tobacco use, and ASA score (less than 3 versus 3 or greater).Introduction
Methods
High body mass index (BMI) is associated with increased rates of complications in primary total hip arthroplasty (THA), but less is known about its impact on cost. The effects of low BMI on outcomes and cost are less understood. This study evaluated the relationship between BMI, inpatient costs, complications, readmissions, and utilization of post-acute services. A retrospective database analysis of 40,913 primary THAs performed between January 2013 and December 2017 in 29 hospitals was conducted. Operating time, length of stay (LOS), complication rate, 30-day readmission rate, inpatient cost, and utilization of post-acute services were measured and compared in relation to patient BMI.Aims
Methods
We present detailed information about early morbidity
after aseptic revision knee replacement from a nationwide study.
All aseptic revision knee replacements undertaken between 1st October
2009 and 30th September 2011 were analysed using the Danish National
Patient Registry with additional information from the Danish Knee
Arthroplasty Registry. The 1218 revisions involving 1165 patients
were subdivided into total revisions, large partial revisions, partial
revisions and revisions of unicondylar replacements (UKR revisions).
The mean age was 65.0 years (27 to 94) and the median length of
hospital stay was four days (interquartile range: 3 to 5), with
a 90 days re-admission rate of 9.9%,
re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges
of 51 to 55 years (p = 0.018), 76 to 80 years (p <
0.001) and ≥ 81
years (p <
0.001) were related to an increased risk of re-admission.
The age ranges of 76 to 80 years (p = 0.018) and the large partial
revision subgroup (p = 0.073) were related to an increased risk
of re-operation. The ages from 76 to 80 years (p <
0.001), age ≥ 81
years (p <
0.001) and surgical time >
120 min (p <
0.001)
were related to increased length of hospital stay, whereas the use
of a tourniquet (p = 0.008) and surgery in a low volume centre (p
= 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative
morbidity after aseptic knee revisions as has been reported after
primary procedures. This suggests that a length of hospital stay ≤ four
days and discharge home at that time is safe following aseptic knee
revision surgery in Denmark. Cite this article:
The April 2023 Shoulder & Elbow Roundup. 360. looks at: Arthroscopic Bankart repair in athletes: in it for the long run?; Functional outcomes and the Wrightington classification of elbow fracture-dislocations; Hemiarthroplasty or ORIF intra-articular distal humerus fractures in older patients; Return to sport after total shoulder arthroplasty and hemiarthroplasty;
The purpose of our study is to examine the outcome of patients undergoing outpatient total hip arthroplasty with a BMI >35. Case-control matching on age, gender (46% female;54%male), and ASA (mean 2.8) with 51 outpatients BMI≥35 kg/m. 2. (mean of 40 (35–55)), mean age of 61 (38–78) matched to 51 outpatients BMI<35 kg/m. 2. (mean of 27 (17–34)) mean age 61 (33–78). Subsequently 47 inpatients BMI≥35 kg/m. 2. (mean of 40 (35–55)) mean age 62 (34–77) were matched outpatients BMI≥35 kg/m. 2. For each cohort, adverse events, readmission in 90 days, reoperations were recorded. Rate of adverse events was significantly higher in BMI ≥35: 15.69% verus 1.96% (p=0.039) with 5 reoperations in the BMI≥35 cohort vs 0 in the BMI<35 kg/m. 2. (p= 0.063).
Abstract. Introduction. 30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions. Method. The pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented. Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes. Results. Prior to implementation, readmission rates following elective primary total knee replacement (TKR) at the 1st business quarter of 2021 (April – June 2021), was 8.7%, (benchmark 3.8%). Following implementation, readmission rates decreased to 4.1% (October – December 2021). 54% of patients making contact were managed with telephone advice. 15% of patients required face-to-face clinic. 32% of those required a same day scan to exclude DVT (1/4). 20 out of 684 TKRs performed following protocol introduction were re-admitted within 30 days.
Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Retrospective review of consecutive arthroplasty cases performed at a District Hospital (DH), and a Tertiary Hospital (TH) in Cape Town, between January 2015 and December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05).
Aims. We aimed to compare the implant survival, complications, readmissions, and mortality of Vancouver B2 periprosthetic femoral fractures (PFFs) treated with internal fixation with that of B1 PFFs treated with internal fixation and B2 fractures treated with revision arthroplasty. Methods. We retrospectively reviewed the data of 112 PFFs, of which 47 (42%) B1 and 27 (24%) B2 PFFs were treated with internal fixation, whereas 38 (34%) B2 fractures underwent revision arthroplasty. Decision to perform internal fixation for B2 PFFs was based on specific radiological (polished femoral components, intact bone-cement interface) and clinical criteria (low-demand patient). Median follow-up was 36.4 months (24 to 60). Implant survival and mortality over time were estimated with the Kaplan-Meier method. Adverse events (measured with a modified Dindo-Clavien classification) and 90-day readmissions were additionally compared between groups. Results. In all, nine (8.01%) surgical failures were detected. All failures occurred within the first 24 months following surgery. The 24-month implant survival was 95.4% (95% confidence interval (CI) 89.13 to 100) for B1 fractures treated with internal fixation, 90% (95% CI 76.86 to 100) for B2 PFFs treated with osteosynthesis-only, and 85.8% (95% CI 74.24 to 97.36) for B2 fractures treated with revision THA, without significant differences between groups (p = 0.296).
INTRODUCTION. In the United States, the Centers for Medicare and Medicaid Services consider rates of unplanned hospital readmissions to be indicators of provider quality. Understanding the common reasons for readmission following total joint arthroplasty will allow for improved standards of care and better outcomes for patients. The current study seeks to evaluate the rates, reasons, and Medicare costs for readmission after total hip and total knee arthroplasty. METHODS. This study used the Limited Data Set (LDS) from the Centers for Medicare and Medicaid Services (CMS) to identify all primary, elective Total Knee Arthroplasties (TKA) and Total Hip Arthroplasties (THA) performed from January 2013 through June 2016. The data were limited to Diagnosis-Related Group (DRG) 470, which is comprised of major joint replacements without major complications or comorbidities.
The aim of this study was to compare open reduction and internal fixation (ORIF) with revision surgery for the surgical management of Unified Classification System (UCS) type B periprosthetic femoral fractures around cemented polished taper-slip femoral components following primary total hip arthroplasty (THA). Data were collected for patients admitted to five UK centres. The primary outcome measure was the two-year reoperation rate. Secondary outcomes were time to surgery, transfusion requirements, critical care requirements, length of stay, two-year local complication rates, six-month systemic complication rates, and mortality rates. Comparisons were made by the form of treatment (ORIF vs revision) and UCS type (B1 vs B2/B3). Kaplan-Meier survival analysis was performed with two-year reoperation for any reason as the endpoint.Aims
Methods
Laxity Differences in CR & PS TKA -Achieving Total Knee Balancing Using Bone Cut Adjustments and Correlation with Varus-Valgus Lift-Off. The Incidence and Mid Term Functional Effect of Partial PCL Recession in Fixed and Mobile Bearing PCL Retaining TKA. Clinical and Radiographic Results of a Modern Design, Onlay Patellofemoral Arthroplasty at a Minimum Two-Year Follow-Up. Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Outcomes at 2 Years Follow-up. Tourniquet Use During TKA -Effect on Recovery of Strength and Function: a randomised, double-blind, control trial. Prospective, Randomised Trial of Standard vs Cross-linked Tibial Poly. Crosslink vs. Conventional TKA Poly Retrieval Analysis. Unplanned
BACKGROUND. As the climate of medicine continues to change, physicians and healthcare administrations seek to improve both the quality of the care we provide patients, as well as reducing the cost at which we provide that care. Delivering value based care is of the utmost importance. The Perioperative Surgical Home (PSH) model is a multidisciplinary team approach to care that has shown success in reducing cost, length of stay, and admission to after care facilities. We sought to compare the results of total knee arthroplasty patients managed in the PSH rapid recovery model, to patients managed in a more traditional fashion. METHODS. We compared 451 patients managed in the PSH model from January 1 to December 31, 2015 to 453 patients managed in a more traditional fashion from January 1 to December 31, 2014. Preoperative. Once identified as potential candidates for total knee arthroplasty, a thorough triage process to optimize patients' medical co-morbidities, educate, and set expectations begins with an evaluation by the preoperative staff and mandatory attendance at a total joint class. Patients were sent for pre-operative physical therapy. Intraoperative. Neuraxial anesthesia was the anesthetic of choice, and perineural analgesia in the form of an adductor canal catheter and single shot posterior capsular injection were used to minimize pain and narcotic usage while maintaining the patient's ability to ambulate with physical therapy early in the post operative course. Additionally, multimodal analgesia was achieved with non- opioid analgesics (acetaminophen, NSAIDS, and gabapentanoids) and limited opioids. Aggressive fluid management and administration of steroids and ketamine also took place intraoperatively. Postoperatively. A multi-disciplinary team led by an orthopaedic surgeon and an anesthesiologist managed the patients throughout their stay. Multimodal analgesia was continued, and there was a rapid de-escalation of care. Physical therapy was initiated in PACU and continued at a minimum of BID thereafter. Patients were eligible for discharge on POD 1 after meeting physical therapy criteria. RESULTS. Average Length of Stay (LOS): 2.86 days in 2014 down to 2.1 in 2015 for an over 25% reduction. Discharge Mix: 71% to home independently or with home health in 2014 increased to 80% in 2015, with a reduction in discharges to a Skilled Nursing Facility from 24% to 16% respectively. 30 Day
A national quality improvement initiative identified potentially avoidable complications, including venous thromboembolism (VTE) as “never events.” While the intent of this designation was to improve system-wide performance and to decrease medical costs, its value in total joint arthroplasty has not been defined. We performed this study to assess the relative incidence of VTE related admissions following TKA, the relative costs associated with care directed towards this complication, and compliance with SCIP VTE prophylaxis guidelines. From a total of 2,221 TKA procedures accomplished over a 5 year interval, we identified 121 hospital readmissions (5.4 percent). Primary readmission diagnoses were obtained from hospital coding and physician medical record documentation.
Revision total knee arthroplasty (rTKA) and revision total hip arthroplasty (rTHA) are complex procedures with higher rates of re-revision, complications, and mortality compared to primary TKA and THA. We report the effects of the establishment of a revision arthroplasty network (the East Midlands Specialist Orthopaedic Network; EMSON) on outcomes of rTKA and rTHA. The revision arthroplasty network was established in January 2015 and covered five hospitals in the Nottinghamshire and Lincolnshire areas of the East Midlands of England. This comprises a collaborative weekly multidisciplinary meeting where upcoming rTKA and rTHA procedures are discussed, and a plan agreed. Using the Hospital Episode Statistics database, revision procedures carried out between April 2011 and March 2018 (allowing two-year follow-up) from the five network hospitals were compared to all other hospitals in England. Age, sex, and mean Hospital Frailty Risk scores were used as covariates. The primary outcome was re-revision surgery within one year of the index revision. Secondary outcomes were re-revision surgery within two years, any complication within one and two years, and median length of hospital stay.Aims
Methods
Medial unicompartmental knee arthroplasty (mUKA) is an advised treatment for anteromedial knee osteoarthritis. While long-term survival after mUKA is well described, reported incidences of short-term surgical complications vary and the effect of surgical usage on complications is less established. We aimed to describe the overall occurrence and treatment of surgical complications within 90 days of mUKA, as well as occurrence in high-usage centres compared to low-usage centres. mUKAs performed in eight fast-track centres from February 2010 to June 2018 were included from the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Database. All readmissions within 90 days of surgery underwent chart review and readmissions related to the surgical wound or the prosthesis were recorded. Centres were categorized as high-usage centres when using mUKA in ≥ 20% of annual knee arthroplasties. The occurrence of complications between high- and low-usage centres were compared using Fisher’s exact test.Aims
Methods
The aim of this study is to assess the impact of a pilot enhanced recovery after surgery (ERAS) programme on length of stay (LOS) and post-discharge resource usage via service evaluation and cost analysis. Between May and December 2019, 100 patients requiring hip or knee arthroplasty were enrolled with the intention that each would have a preadmission discharge plan, a preoperative education class with nominated helper, a day of surgery admission and mobilization, a day one discharge, and access to a 24/7 dedicated helpline. Each was matched with a patient under the pre-existing pathway from the previous year.Aims
Methods
Literature surrounding artificial intelligence (AI)-related applications for hip and knee arthroplasty has proliferated. However, meaningful advances that fundamentally transform the practice and delivery of joint arthroplasty are yet to be realized, despite the broad range of applications as we continue to search for meaningful and appropriate use of AI. AI literature in hip and knee arthroplasty between 2018 and 2021 regarding image-based analyses, value-based care, remote patient monitoring, and augmented reality was reviewed. Concerns surrounding meaningful use and appropriate methodological approaches of AI in joint arthroplasty research are summarized. Of the 233 AI-related orthopaedics articles published, 178 (76%) constituted original research, while the rest consisted of editorials or reviews. A total of 52% of original AI-related research concerns hip and knee arthroplasty (n = 92), and a narrative review is described. Three studies were externally validated. Pitfalls surrounding present-day research include conflating vernacular (“AI/machine learning”), repackaging limited registry data, prematurely releasing internally validated prediction models, appraising model architecture instead of inputted data, withholding code, and evaluating studies using antiquated regression-based guidelines. While AI has been applied to a variety of hip and knee arthroplasty applications with limited clinical impact, the future remains promising if the question is meaningful, the methodology is rigorous and transparent, the data are rich, and the model is externally validated. Simple checkpoints for meaningful AI adoption include ensuring applications focus on: administrative support over clinical evaluation and management; necessity of the advanced model; and the novelty of the question being answered. Cite this article:
Tranexamic acid (TXA) is now commonly used in major surgical operations including orthopaedics. The TRAC-24 randomized control trial (RCT) aimed to assess if an additional 24 hours of TXA postoperatively in primary total hip (THA) and total knee arthroplasty (TKA) reduced blood loss. Contrary to other orthopaedic studies to date, this trial included high-risk patients. This paper presents the results of a cost analysis undertaken alongside this RCT. TRAC-24 was a prospective RCT on patients undergoing TKA and THA. Three groups were included: Group 1 received 1 g intravenous (IV) TXA perioperatively and an additional 24-hour postoperative oral regime, Group 2 received only the perioperative dose, and Group 3 did not receive TXA. Cost analysis was performed out to day 90.Aims
Methods
The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation.Aims
Methods
While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA. Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry. Six routinely ordered preoperative blood markers - albumin, haematocrit, platelet count, white blood cell count (WBC), estimated glomerular filtration rate (eGFR), and sodium level - were queried. The association between preoperative blood marker values and all-cause readmission within 30 days of surgery was compared using univariable analysis and multivariable logistic regression adjusted for relevant patient and treatment factors.Aims
Methods
Day-case arthroplasty is gaining popularity in Europe. We report outcomes from the first 12 months following implementation of a day-case pathway for unicompartmental knee arthroplasty (UKA) and total hip arthroplasty (THA) in an NHS hospital. A total of 47 total hip arthroplasty (THA) and 24 unicompartmental knee arthroplasty (UKA) patients were selected for the day-case arthroplasty pathway, based on preoperative fitness and agreement to participate. Data were likewise collected for a matched control group (n = 58) who followed the standard pathway three months prior to the implementation of the day-case pathway. We report same-day discharge (SDD) success, reasons for delayed discharge, and patient-reported outcomes. Overall length of stay (LOS) for all lower limb arthroplasty was recorded to determine the wider impact of implementing a day-case pathway.Aims
Methods
Deep surgical site infection (SSI) remains an unsolved problem after hip fracture. Debridement, antibiotic, and implant retention (DAIR) has become a mainstream treatment in elective periprosthetic joint infection; however, evidence for DAIR after infected hip hemiarthroplaty is limited. Patients who underwent a hemiarthroplasty between March 2007 and August 2018 were reviewed. Multivariable binary logistic regression was performed to identify and adjust for risk factors for SSI, and to identify factors predicting a successful DAIR at one year.Aims
Methods
Open reduction in developmental dysplasia of the hip (DDH) is regularly performed despite screening programmes, due to failure of treatment or late presentation. A protocol for open reduction of DDH has been refined through collaboration between surgical, anaesthetic, and nursing teams to allow same day discharge. The objective of this study was to determine the safety and feasibility of performing open reduction of DDH as a day case. A prospectively collected departmental database was visited. All consecutive surgical cases of DDH between June 2015 and March 2020 were collected. Closed reductions, bilateral cases, cases requiring corrective osteotomy, and children with comorbidities were excluded. Data collected included demographics, safety outcome measures (blood loss, complications, readmission, reduction confirmation), and feasibility for discharge according to the Face Legs Activity Cry Consolidability (FLACC) pain scale. A satisfaction questionnaire was filled by the carers. Descriptive statistics were used for analysis.Aims
Methods
The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018. We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as ‘outpatient’ and ‘inpatient’ TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018.Aims
Methods
The aim of this study was to report our experience at 3.5 years with outpatient total hip arthroplasty (THA). In this prospective cohort study, we included all patients who were planned to receive primary THA through the anterior approach between 1 April 2014 and 1 October 2017. Patient-related data and surgical information were recorded. Patient reported outcome measures (PROMs) related to the hip and an anchor question were taken preoperatively, at six weeks, three months, and one year after surgery. All complications, readmissions, and reoperations were registered.Aims
Methods
Data on early morbidity and complications after
revision total hip replacement (THR) are limited. The aim of this nationwide
study was to describe and quantify early morbidity after aseptic
revision THR and relate the morbidity to the extent of the revision
surgical procedure. We analysed all aseptic revision THRs from 1st
October 2009 to 30th September 2011 using the Danish National Patient
Registry, with additional information from the Danish Hip Arthroplasty
Registry. There were 1553 procedures (1490 patients) performed in
40 centres and we divided them into total revisions, acetabular
component revisions, femoral stem revisions and partial revisions.
The mean age of the patients was 70.4 years (25 to 98) and the median
hospital stay was five days (interquartile range 3 to 7). Within 90
days of surgery, the readmission rate was 18.3%, mortality rate
1.4%, re-operation rate 6.1%, dislocation rate 7.0% and infection
rate 3.0%. There were no differences in these outcomes between high-
and low-volume centres. Of all readmissions, 255 (63.9%) were due
to ‘surgical’ complications Cite this article: