Establishing a patient centered, outpatient total joint home recovery program within an integrated healthcare system

2020 ◽  
Vol 10 (1) ◽  
pp. 23-41
Author(s):  
Paul David Weyker ◽  
Christopher Allen-John Webb
Keyword(s):  
Total Joint Arthroplasty ◽  
Physical Therapists ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Multidisciplinary Teams ◽  
Patient Centered ◽  
Eligibility Criteria ◽  
Hospital Administrators ◽  
Home Health Services ◽  
Recovery Program

Outpatient total joint home recovery (HR) is a rapidly growing initiative being developed and employed at high volume orthopedic centers. Minimally invasive surgery, improved pain control and home health services have made HR possible. Multidisciplinary teams with members ranging from surgeons and anesthesiologists to hospital administrators, physical therapists, nurses and research analysts are necessary for success. Eligibility criteria for outpatient total joint arthroplasty will vary between medical centers. Surgeon preference in addition to medical comorbidities, social support, preoperative patient mobility and safety of the HR location are all factors to consider when selecting patients for outpatient total joint HR. As additional knowledge is gained, the next steps will be to establish ‘best practices’ and speciality society-endorsed guidelines for patients undergoing outpatient total joint arthroplasty.

scholarly journals Integration of Patient-reported Outcomes in a Total Joint Arthroplasty Program at a High-volume Academic Medical Center

2020 ◽  
Vol 4 (5) ◽  
pp. e20.00034 ◽  
Author(s):  
Surabhi Bhatt ◽  
Kristina Davis ◽  
David W. Manning ◽  
Cynthia Barnard ◽  
Terrance D. Peabody ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Volume ◽  
Joint Arthroplasty ◽  
Academic Medical ◽  
Patient Reported

A Preliminary Examination of the CMS Eligibility Criteria in Total-Joint Arthroplasty

2006 ◽  
Vol 85 (11) ◽  
pp. 872-881 ◽  
Author(s):  
Kevin R. Vincent ◽  
Laura W. Lee ◽  
JenPin Weng ◽  
Alan P. Alfano ◽  
Heather K. Vincent
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Eligibility Criteria ◽  
Preliminary Examination

scholarly journals Developing a Pathway for High-value, Patient-centered Total Joint Arthroplasty

2013 ◽  
Vol 472 (5) ◽  
pp. 1619-1635 ◽  
Author(s):  
Aricca D. Van Citters ◽  
Cheryl Fahlman ◽  
Donald A. Goldmann ◽  
Jay R. Lieberman ◽  
Karl M. Koenig ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Patient Centered

scholarly journals Impact of chronic kidney disease on outcomes after total joint arthroplasty: A meta-analysis & systematic review.

2019 ◽  
Author(s):  
Jiang Chen ◽  
Fan Zhang ◽  
Chu-Yin Liu ◽  
Qiao-Mei Yuan ◽  
Xue-Shi Di ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Total Joint Arthroplasty ◽  
Meta Analysis ◽  
Joint Arthroplasty ◽  
Adverse Outcomes ◽  
Eligibility Criteria ◽  
Manual Search ◽  
Increased Risk ◽  
Ckd Stage

Abstract Background Comorbidities in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) may compromise outcomes with increased hospital stays, readmission and mortality rates. We aimed to determine whether chronic kidney disease (CKD) affects postoperative outcomes of patients undergoing total joint arthroplasty (TJA).Methods To identify studies for this review and meta-analysis, two independent reviewers searched PubMed, Cochrane, EMBASE and Google Scholar until April 1, 2019, and identified additional studies by manual search of reference lists. Prospective or retrospective studies with quantitative outcomes for patients undergoing TJA were selected. Outcomes were compared between patients with underlying CKD stage >=3 or eGFR< 60 mL/min/1.73 m2 versus mild/non-CKD as controls. Main endpoints were mortality, re-operation and re-admission rates.Results Among 59 studies reviewed, 19 meeting the eligibility criteria were included, providing data of 2,141,393 patients. After THA or TKA, CKD was associated with higher mortality risk than non-CKD (pooled OR 2.20, 95%CI = 1.90 to 2.54; P < 0.001); no significant differences were seen in re-operation between CKD and non-CKD patients (pooled OR 1.26, 95%CI = 0.84 to 1.88; P=0.266); and CKD patients had higher any-cause re-admission rates (pooled OR= 1.57, 95%CI = 1.27 to 1.94, P<0.001).Conclusion Underlying CKD predicts adverse outcomes after elective TJA with increased risk of mortality, re-admission, surgical site infection, and perioperative transfusion. Findings of this review and meta-analysis highlight CKD as a critical contributor to complications after TJA and may be helpful to surgeons when advising patients about associated risks of TJA.

scholarly journals Equivalent VTE rates after total joint arthroplasty using thromboprophylaxis with aspirin versus potent anticoagulants: retrospective analysis of 4562 cases across a diverse healthcare system

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Chelsea Matzko ◽  
Zachary P. Berliner ◽  
Gregg Husk ◽  
Bushra Mina ◽  
Barton Nisonson ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
High Volume ◽  
Antiplatelet Agents ◽  
Joint Arthroplasty ◽  
Bivariate Analysis ◽  
Supporting Evidence ◽  
Case Volume ◽  
Vte Prophylaxis ◽  
Lower Volume ◽  
Hip And Knee Arthroplasty

Abstract Background Guidelines support aspirin thromboprophylaxis for primary total hip and knee arthroplasty (THA and TKA) but supporting evidence has come from high volume centers and the practice remains controversial. Methods We studied 4562 Medicare patients who underwent elective primary THA (1736, 38.1%) or TKA (2826, 61.9%) at 9 diverse hospitals. Thirty-day claims data were combined with data from the health system’s electronic medical records to compare rates of venous thromboembolism (VTE) between patients who received prophylaxis with: (1) aspirin alone (47.3%), (2) a single, potent anticoagulant (29%), (3) antiplatelet agents other than aspirin or multiple anticoagulants (21.5%), or (4) low-dose subcutaneous unfractionated heparin or no anticoagulation (2.2%). Sub-analyses separately evaluating THA, TKA and cases from lower volume hospitals (n = 975) were performed. Results The 30-day VTE incidence was 0.6% (29/4562). VTE rates were equal in patients receiving aspirin and those receiving a single potent anticoagulant (0.5% in both groups). Patients with VTE were significantly older than patients without VTE (mean 76.5 vs. 73.1 years, P = 0.04). VTE rate did not associate with sex or hospital case volume. On bivariate analysis considering age, aspirin did not associate with greater VTE risk compared to a single potent anticoagulant (OR = 2.1, CI = 0.7–6.3) with the numbers available. Odds of VTE were increased with use of subcutaneous heparin or no anticoagulant (OR = 6.4, CI = 1.2–35.6) and with multiple anticoagulants (OR = 3.6, CI = 1.1–11.2). THA and TKA demonstrated similar rates of VTE (0.5% vs. 0.7%, respectively, P = 0.43). Of 975 cases done at lower volume hospitals, 387 received aspirin, none of whom developed VTE. Conclusions This study provides further support for aspirin as an effective form of pharmacological VTE prophylaxis after total joint arthroplasty in the setting of a multi-modal regimen using 30-day outcomes. VTE occurred in 0.7% of primary joint arthroplasties. Aspirin prophylaxis did not associate with greater VTE risk compared to potent anticoagulants in the total population or at lower volume hospitals.

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