Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Knee Arthroplasty?

2019 ◽  
Vol 34 (8) ◽  
pp. 1570-1574 ◽  
Author(s):  
Nima Eftekhary ◽  
James E. Feng ◽  
Afshin A. Anoushiravani ◽  
Ran Schwarzkopf ◽  
Jonathan M. Vigdorchik ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Healthcare Providers ◽  
Patient Demographics ◽  
Hospital Consumer Assessment ◽  
Total Knee ◽  
Consumer Assessment

scholarly journals Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257555
Author(s):  
Michael R. Mercier ◽  
Anoop R. Galivanche ◽  
Wyatt B. David ◽  
Rohil Malpani ◽  
Neil Pathak ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Healthcare Providers ◽  
Patient Characteristics ◽  
Postoperative Outcomes ◽  
Hospital Consumer Assessment ◽  
Survey Results ◽  
Total Knee ◽  
Consumer Assessment ◽  
Hcahps Survey

Introduction The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients’ satisfaction of their hospital experience. A minority of discharged patients return the survey. Underlying bias among who ultimately returns the survey (non-response bias) after total knee arthroplasty (TKA) may affect results of the survey. Thus, the objective of the current study is to assess the relationship between patient characteristics and postoperative outcomes on HCAHPS survey nonresponse. Methods All adult patients at a single institution undergoing inpatient, elective, primary TKA between February 2013 and May 2020 were selected for analysis. Following discharge, all patients had been mailed the HCAHPS survey. The primary outcome analyzed in the current study is survey return. Patient characteristics, surgical variables, and 30-day postoperative outcomes were analyzed. Univariate and multivariate analyses were performed to identify factors independently associated with return of the HCAHPS survey. Results Of 4,804 TKA patients identified, 1,498 (31.22%) returned HCAHPS surveys. On multivariate regression analyses controlling for patient factors, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (ASA score of 4 or higher, OR = 2.37; P<0.001), and be partially or totally dependent (OR = 2.37; P = 0.037). Similarly, patients who did not return the survey were more likely to have had a readmission (OR = 1.94; P<0.001), be discharged to a place other than home (OR = 1.52; P<0.001), or stay in the hospital for longer than 3 days (OR = 1.43; P = 0.004). Discussion Following TKA, HCAHPS survey response rate was only 31.22% and completion of the survey was associated with several demographic and postoperative variables. These findings suggest that HCAHPS survey results capture a non-representative fraction of the true TKA patient population. This bias is necessary to consider when using HCAHPS survey results as a metric for quality of healthcare and federal reimbursement rates.

Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients

2021 ◽  
Author(s):  
Kevin Zhai ◽  
Melissa Orr ◽  
Daniel Grits ◽  
Ahmed K. Emara ◽  
Christopher A. Rothfusz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Mortality Rate ◽  
Knee Arthroplasty ◽  
Preoperative Diagnosis ◽  
Mortality Rates ◽  
Male Gender ◽  
Improvement Program ◽  
Patient Demographics ◽  
Comorbidity Burden ◽  
Total Knee

AbstractDespite its rarity, the risk of mortality following primary elective total knee arthroplasty (TKA) is a critical component of surgical decision-making and patient counseling. The purpose of our study was to (1) determine the overall 30-day mortality rate for unilateral primary elective TKA patients, (2) determine the 30-day mortality rates when stratified by age, comorbidities, and preoperative diagnosis, and (3) identify the distribution of (i) patient demographics, (ii) baseline comorbidities, and (iii) preoperative diagnoses between mortality and mortality-free cohorts. A total of 326,157 patients underwent primary elective TKA (2011–2018) were identified through retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into 30-day mortality (n = 320) and mortality-free (n = 325,837) cohorts. Patient demographics, preoperative comorbidities, and preoperative diagnoses were compared. Age group, American Society of Anesthesiology (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. The overall mortality rate was 0.098%. Older age (p < 0.001) and male gender (p < 0.001) were associated with increased mortality. There was no association between mortality and race (p = 0.346) or body mass index (BMI) class (p = 0.722). All reported comorbidities except smoking status were significantly greater in the mortality cohort (p < 0.05). For ASA scores of I, II, III, and IV, the number of deaths per 1,000 were 0.16, 0.47, 1.4, and 4.4, respectively. For CCI scores of 0, 1, 2, 3, 4, and 6, mortality rates per 1,000 were 0.76, 2.1, 7.0, 11, 29, and 7.6, respectively. Mortality rates for a preoperative diagnosis of osteoarthritis (OA) versus non-OA were, respectively, 0.096% and 0.19% (p < 0.001). Increased age, male gender, increased comorbidity burden, and non-OA preoperative diagnoses are associated with higher rates of 30-day postoperative mortality. There were no significant associations between BMI or race and 30-day mortality. These findings aid in identifying of higher-risk patients, who can then receive appropriate counseling or preoperative interventions to reduce the risk of perioperative mortality.

scholarly journals Predictors of Patient Satisfaction in Hand and Upper Extremity Clinics

2019 ◽  
Vol 11 (03) ◽  
pp. 146-150
Author(s):  
Ashkaun Shaterian ◽  
Lohrasb Ross Sayadi ◽  
Pauline F. Joy Santos ◽  
Chloe Krasnoff ◽  
Gregory R. D. Evans ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Upper Extremity ◽  
Medical Center ◽  
Healthcare Providers ◽  
Clinical Marker ◽  
Patient Demographics ◽  
Appointment Time ◽  
Hospital Consumer Assessment ◽  
Willingness To Refer ◽  
Consumer Assessment

Abstract Introduction Patient satisfaction is an important clinical marker for hand/upper extremity patients. Few studies have investigated the predictors of patient satisfaction in the clinic setting. Our objective was to analyze patient satisfaction surveys to explore factors that influence patient satisfaction. Materials and Methods We conducted a retrospective analysis assessing patient satisfaction in the hand/upper extremity clinics at our university medical center between 2012 and 2018. Patient satisfaction was assessed via Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Patient demographics, satisfaction scores, and clinic experience questionnaire responses were evaluated. Statistical analysis was conducted to identify significant trends. Results Between 2012 and 2018, 102 surveys were completed. Scores ranged from 5 to 10 with an average provider rating of 9.56. We found six factors significantly influenced patient satisfaction: adequate time was spent with the provider, provider showed respect, patient was seen by provider within 15 minutes of appointment time, provider listened sufficiently, patient received understandable medical instructions, and understandable medical explanations (p < 0.05). Conclusion Achieving patient satisfaction is an important clinical marker in hand/upper extremity clinics. Patient satisfaction has defined predictors wherein various clinical factors can influence patient satisfaction and willingness to refer their provider to other patients.

Range of Motion at Discharge Predicts Need for Manipulation Following Total Knee Arthroplasty

2019 ◽  
Author(s):  
Kristen M. LaHaise ◽  
Daniel V. Vargo ◽  
Gustavo A. Barrazueta ◽  
James G. Nairus ◽  
James V. Bono ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Common Complication ◽  
Single Institution ◽  
Manipulation Under Anesthesia ◽  
Joint Registry ◽  
Patient Demographics ◽  
Confounding Variables ◽  
Total Knee

Stiffness following total knee arthroplasty (TKA) is a common complication that can result in unsatisfactory outcomes. Manipulation under anesthesia (MUA) has been widely employed to treat this problem. It is uncertain whether an association exists between range of motion (ROM) at discharge and need for MUA following primary TKA.A retrospective review of an institutional joint registry identified cases of primary TKA performed by three surgeons at a single institution over a 22-month period. A logistic regression model was used to examine the association between ROM at discharge and subsequent MUA controlling for confounding variables related to patient demographics and perioperative details.Of the 1,546 cases identified, 113 (7.3%) cases underwent subsequent MUA. As discharge ROM increased, manipulation rates decreased. Patients with discharge flexion <65 degrees were more likely to undergo MUA than those with flexion >90 degrees (odds ratio [OR] = 17.57, 95% confidence interval [CI] [7.97, 38.73], p < 0.0001). The largest differential in odds of MUA was observed between the <65 degrees at discharge group (OR = 17.57) and the 65 ≤ 75 degrees at discharge group (OR = 7.89). At discharge ROM of 80 ≤ 90 degrees of flexion, patients had more than a twofold increase in odds of MUA relative to those in the >90 degrees group (OR = 2.22, 95% CI [1.20, 4.10], p = 0.011).The results of this study suggest that there is an association between lower ROM at discharge and greater risk of MUA post primary TKA. Counseling patients in regard to discharge ROM and associated risk of MUA may optimize gains in ROM during recovery.

scholarly journals Epidemiology of adolescent total knee arthroplasty patient and a comparison to adult patient demographics

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Samantha Nguyen ◽  
Katelyn Pratt ◽  
Mouhanad M El-Othmani ◽  
Tony Tzeng ◽  
Steven Scaife ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adult Patient ◽  
Knee Arthroplasty ◽  
Total Knee Arthroplasty Patient ◽  
Patient Demographics ◽  
Total Knee

scholarly journals Incidence of Drug Abuse in Revision Total Knee Arthroplasty Population

2018 ◽  
Vol 31 (10) ◽  
pp. 928-933 ◽  
Author(s):  
Martin Roche ◽  
Tsun Law ◽  
Nipun Sodhi ◽  
Samuel Rosas ◽  
Jennifer Kurowicki ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Drug Abuse ◽  
Knee Arthroplasty ◽  
Postoperative Pain Management ◽  
Revision Total Knee Arthroplasty ◽  
Alcohol Abusers ◽  
Patient Demographics ◽  
Increased Risk ◽  
Primary Tkas ◽  
Total Knee

AbstractSubstance abuse can have strong negative impacts on surgical outcomes. Therefore, this study assessed the effects of drug abuse in total knee arthroplasty (TKA) patients. Specifically, we identified revision TKA (RTKA): (1) incidence, (2) causes, (3) time to revision, and (4) patient demographics in patients with a history of drug abuse. The Medicare database within the PearlDiver Supercomputer (Warsaw, IN) was queried to identify 2,159,221 TKAs performed between 2005 and 2012. Drug abuse was subdivided into cocaine, cannabis, opioids, sedatives/hypnotics/anxiolytics (SHA), amphetamines, and alcohol abusers. The effect of drug use on the incidence and cause for RTKA, time to revision, as well as patient demographics were correlated using multivariate, analysis of variance, and regression analyses. There was a significant increase in the number of primary TKAs in cocaine (p = 0.011), cannabis (p < 0.001), opioid (p < 0.001), SHA (p < 0.001), amphetamine (p < 0.001), and alcohol (p < 0.001) users. Amphetamine users had the fastest mean time to revision (691 days, standard deviation: 679 days). At 30-, 90-day, and 6-month postoperative, cocaine had the highest proportion of patients requiring RTKA (7, 12, and 20%, respectively), and at 1-year alcohol abusers (38%, p < 0.001). Infection was the most common cause of revision in all drug abuse/dependent cohorts. Age distributions varied significantly by group for primary TKA (p < 0.001). Comorbidity status was similar in all RTKA patients as determined by comparison of the mean Charlson comorbidity index scores (p = 0.091). Based on these results, drug abuse patients are at increased risk for RTKA. These high-risk patients should, therefore, be appropriately risk stratified and receive comprehensive postoperative pain management.

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