Examining Length of Stay and Home Discharge when Using Bupivacaine Liposomal Injectable Suspension in Medicare Patients Undergoing Total Hip Arthroplasty

Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients. Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay. No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches. Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes. Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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Evidence-Based Thresholds for the Volume and Length of Stay Relationship in Total Hip Arthroplasty: Outcomes and Economies of Scale

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.01.059 ◽

2018 ◽

Vol 33 (7) ◽

pp. 2031-2037 ◽

Cited By ~ 15

Author(s):

Prem N. Ramkumar ◽

Sergio M. Navarro ◽

William C. Frankel ◽

Heather S. Haeberle ◽

Ronald E. Delanois ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Economies Of Scale ◽

Evidence Based ◽

Total Hip

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Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients

Hip International ◽

10.1177/1120700018816924 ◽

2018 ◽

Vol 29 (6) ◽

pp. 674-679 ◽

Cited By ~ 3

Author(s):

Scott M Eskildsen ◽

Ganesh V Kamath ◽

Daniel J Del Gaizo

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Neck ◽

Hip Arthroplasty ◽

Femoral Neck Fractures ◽

National Database ◽

Medicare Patient ◽

Entire Study ◽

Total Hip ◽

Significant Difference ◽

Medicare Patients

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

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COMPARISON OF TOTAL HOSPITAL CHARGES AND COSTS USING CHARGEMASTER DATA FROM PREMIER FOR MEDICARE PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY

Value in Health ◽

10.1016/j.jval.2016.03.1127 ◽

2016 ◽

Vol 19 (3) ◽

pp. A229

Author(s):

S. Dagenais ◽

A. Kang ◽

R. Scranton

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hospital Charges ◽

Total Hospital ◽

Total Hip ◽

Medicare Patients

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Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.08.039 ◽

2020 ◽

Author(s):

David E. DeMik ◽

Christopher N. Carender ◽

Natalie A. Glass ◽

John J. Callaghan ◽

Nicholas A. Bedard

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Total Hip ◽

Home Discharge ◽

Large Databases

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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