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Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 541 - 541
1 Dec 2013
Higuera C Styron J Strnad G Barsoum W Iannotti J
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Introduction:

Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient's mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA.

Methods:

Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models that were adjusted for all variables, including baseline mental and functional scores.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_34 | Pages 348 - 348
1 Dec 2013
Higuera C Styron J Strnad G Iannotti J
Full Access

Introduction:

Total knee arthroplasty (TKA) outcomes drive assessment of quality and reinvestment; therefore a risk stratified assessment is paramount for fair evaluation. Stratification can be affected by multiple factors including patient motivation. This study attempted to identify the correlation of patient's preoperative confidence in their ability to return to desired activity level after TKA and improved function and outcomes.

Methods:

A continuous series of TKA procedures from 2008 to 2010 in a healthcare system was reviewed retrospectively. Patients included reported pre- and postoperative knee injury and osteoarthritis outcomes scores (KOOS), SF-12 scores, and responded a question regarding the desired activity level, including the level of confidence (0–10 scale) in attaining such goals, after surgery. Gender, age, body mass index, education level, smoking status, length of stay (LOS), 30-day readmission and reoperation, and 1-year infection rates were collected. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models adjusted for baseline mental and functional scores.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 12 - 12
1 Mar 2010
Klika A Barsoum WK Gad B Styron J Green K Bershadsky B Pifer M
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Purpose: The current health care climate encourages an early discharge directly home. Efforts to increase efficiency and decrease length of stay require accurate pre-planning of patient discharge following total joint arthroplasty (TJA). The purpose of this study was to develop and evaluate an easily administered form to preoperatively predict patient discharge disposition following TJA.

Method: A form was generated by a multidisciplinary group of clinicians which identified a set of preoperative factors relevant to patient discharge including age, gender, body mass index, comorbidities, preoperative ambulatory status, projected postoperative weight bearing, home environment and location, and caregiver assistance. Data were collected from a retrospective review of 516 medical charts for patients that had undergone primary total knee arthroplasty (TKA) (n=103), revision TKA (n=104), bilateral TKA (n=102), primary total hip arthroplasty (THA) (n=106), and revision THA (n=101). A stepwise multinomial logistic regression model was used to identify predictors of discharge to a skilled nursing facility (SNF), rehabilitation facility, or home, using SPSS version 11.5 statistical software (SPSS Inc., Chicago, IL).

Results: Patients were more likely to be discharged to either a SNF or rehabilitation facility if they underwent bilateral TKA (p< 0.001); were female (p< 0.001), have their heart disease monitored (p=0.003); or are older (p< 0.001). Patients are more likely to be discharged home if preoperatively they are capable of independent ambulation in the community (p=0.014). Patients discharged to either a SNF or rehabilitation facility were not significantly different except patients undergoing bilateral TKA were more likely to be discharged to a rehabilitation facility (p< 0.001).

Conclusion: We identified factors associated with discharge to a SNF, rehabilitation facility, or home following elective joint replacement surgery. With further validation, this model may be a useful tool for preoperatively predicting a patient’s discharge disposition, which is valuable to the hospital, clinicians, patients, and families in efficiently preparing for postoperative care.