Introduction:Outpatient and accelerated recovery total joint arthroplasty (TJA) programs have become standard for private and academic practices. County hospitals traditionally serve patients with limited access to TJA and psychosocial factors which create challenges for accelerated recovery. The effectiveness of such programs at a county hospital has not been reported.Methods:In 2017, our county hospital implemented an accelerated recovery protocol for all TJA patients. This protocol consisted of standardized, preoperative medical and psychosocial optimization, perioperative spinal anesthesia, tranexamic acid and local infiltration analgesia use, postoperative emphasis on non-narcotic analgesia, and early mobilization. LOS, complications, disposition, and cost were compared between patients treated before and after protocol implementation.Results:In 15 months, 108 primary TJA patients were treated. Compared with the previous 108 TJA patients, LOS dropped from 3.4 to 1.6 days (P < 0.001), more patients discharged home (92% versus 72%, P < 0.001), average hospitalization and procedure-specific costs decreased 24.7% and 22.1%, respectively, and were significantly fewer complications (7% versus 21%, P = 0.007).Conclusions:Implementation of an accelerated recovery TJA program at a County Hospital is novel. This implementation requires careful patient selection and a coordinated multidisciplinary approach and is a safe and cost-effective method of delivering high-quality care to an underserved cohort.
all claims-based ICU studies are still using ICD-9 codes. Although we would not expect the ICD-10 crosswalk to yield different results, future studies are needed to address this issue.On the basis of these findings, we recommend that researchers can use ICD-9 procedure codes for mechanical ventilation alone to identify populations of mechanically ventilated patients in administrative data, with the understanding that the population captured will not represent the entire population of mechanically ventilated patients. These data suggest that researchers can be confident that identified patients will have truly been ventilated and will help characterize the patients who may have been missed by ICD-9 procedure codes. n
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