Outcomes of simultaneous bilateral total hip arthroplasty for 256 selected patients in a single surgeon’s practice

Aims Total hip arthroplasty (THA) using the direct anterior approach (DAA) is undertaken with the patient in the supine position, creating an opportunity to replace both hips under one anaesthetic. Few studies have reported simultaneous bilateral DAA-THA. The aim of this study was to characterize a cohort of patients selected for this technique by a single, high-volume arthroplasty surgeon and to investigate their early postoperative clinical outcomes. Methods Using an institutional database, we reviewed 643 patients who underwent bilateral DAA-THA by a single surgeon between 1 January 2010 and 31 December 2018. The demographic characteristics of the 256 patients (39.8%) who underwent simultaneous bilateral DAA-THA were compared with the 387 patients (60.2%) who underwent staged THA during the same period of time. We then reviewed the length of stay, rate of discharge home, 90-day complications, and readmissions for the simultaneous bilateral group. Results Patients undergoing simultaneous bilateral DAA-THA had a 3.5% transfusion rate, a 1.8 day mean length of stay, a 98.1% rate of discharge home, and low rates of 90-day infection (0.39%), dislocation (0.39%), periprosthetic fracture (0.77%), venous thromboembolism (0%), haematoma (0.39%), further surgery (0.77%), and readmission (0.77%). These patients were significantly younger (mean 58.2 years vs 62.5 years; p < 0.001), more likely to be male (60.3% vs 46.5%; p < 0.001), and with a trend towards having a lower mean BMI (27.8 kg/m2 vs 28.4 kg/m2; p = 0.071) than patients who underwent staged bilateral DAA-THA. Conclusion Patients selected for simultaneous bilateral DAA-THA in a single surgeon’s practice had a 3% rate of postoperative transfusion and a low rate of complications, readmissions, and discharge to a rehabilitation facility. Simultaneous bilateral DAA-THA appears to be a reasonable and safe form of treatment for patients with bilateral symptomatic osteoarthritis of the hip when undertaken by an experienced arthroplasty surgeon with appropriate selection criteria. Cite this article: Bone Joint J 2021;103-B(7 Supple B):116–121.

Applying Health-Six-Sigma Principles Helps Reducing the Variability of Length of Stay in the Emergency Department

ABSTRACT Background Reducing length of stay (LOS) is one of the urgent problems in health care systems worldwide. Popular methods that are used to reduce LOS are the Lean and the 6 Sigma, which in practice result in limited improvements. In this paper we introduce and test a tailored method for implementing the 6 Sigma principles in healthcare (we call H-6S). Methods The study took place within the emergency department (ED) of the "Josephtal Medical Center" in Eilat, Israel. Our analysis focused on the processes of examining and treating patients from admission to ED until discharge home. The analysis was done during the second quarter of 2018. The implementation of the recommendations took place during Q3 2018. The reported results are from Q3 2018 to Q2 2019, compared to the corresponding period in 2017 (experienced team). Results In Q2 2017 LOS was 2.42h ± 2.07h (experienced team, N=9928). In Q2 2018, the LOS was 2.62h± 7.04h (before the H-6S, inexperienced team, N=9484). In Q2 2019 following the intervention it reached 2.3h±1.74h (N=7647). The differences between the SDs of the three periods are significant. Conclusion Implementing H-6S dropped variance of LOS within 3 months and remained low for the whole year. Each new team of physicians who enters the emergency department should be thoroughly instructed as to the routines and expectations of the system from them, which should narrow the differences of previous education between them.