Ethics of Provider Risk Factor Modification in Total Joint Arthroplasty

Bronson, Wesley H.; Lindsay, David; Lajam, Claudette M.; Iorio, Richard; Caplan, Arthur L.; Bosco, Joseph

doi:10.2106/jbjs.o.00564

Cited by 18 publications

(10 citation statements)

References 29 publications

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“…This study is unique among the current literature in that it was performed at a single, high-volume institution. Previous database studies cannot control for lower socioeconomic patients more often presenting to low-volume centers [18]. There are inherent limitations in the retrospective nature of this study.…”

Section: Discussionmentioning

confidence: 95%

“…Therefore, patients with lower socioeconomic status and perceived modifiable risk factors, both groups whom have traditionally had less access to care, may face additional challenges in obtaining care [17]. Aggressive risk factor modification and patient selection is ethically challenging given those who are underinsured or uninsured are the patients who suffer the most loss of access [18]. But socioeconomic status may be an even more important risk factor for healthcare utilization and subsequently penalization under the CJR after total hip replacement.…”

Section: Discussionmentioning

confidence: 99%

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Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Joseph

Perez

et al. 2022

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Joseph

Perez

et al. 2022

The Journal of Arthroplasty

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“…37 Efficient delivery of medical care minimizes the financial stress on the healthcare system. 37 It has been demonstrated that rates of revision surgery and mortality after TJA are less with high-volume physicians and centers than with low-volume alternatives (,125 cases per year). [37][38][39] However, patients referred from a local community hospital to high-volume regional centers might travel more than 50 to 100 miles to minimize the provider risk.…”

Section: Risk Factor Modificationmentioning

confidence: 99%

“…37 It has been demonstrated that rates of revision surgery and mortality after TJA are less with high-volume physicians and centers than with low-volume alternatives (,125 cases per year). [37][38][39] However, patients referred from a local community hospital to high-volume regional centers might travel more than 50 to 100 miles to minimize the provider risk. 37 This outmigration of TJA to regionalized centers might cause a negative effect on low-volume centers and local communities.…”

Section: Risk Factor Modificationmentioning

confidence: 99%

“…[37][38][39] However, patients referred from a local community hospital to high-volume regional centers might travel more than 50 to 100 miles to minimize the provider risk. 37 This outmigration of TJA to regionalized centers might cause a negative effect on low-volume centers and local communities. 37 Regionalized referral of patients might also have a negative impact on justice and patient autonomy by limiting a patient's choice of surgeon or hospital.…”

Section: Risk Factor Modificationmentioning

confidence: 99%

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Ethical Considerations in Total Joint Arthroplasty

Tarwala,

Mercuri,

Iorio

et al. 2023

J Am Acad Orthop Surg

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Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy–relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.

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Perioperative Management in Reverse Total Shoulder Arthroplasty

Godlewski

Knudsen

Braman

et al. 2021

Curr Rev Musculoskelet Med

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Purpose of Review A successful reverse total shoulder arthroplasty requires careful preoperative planning and perioperative management. Preoperative comorbidity risks, perioperative pain management, and postoperative rehabilitation are all critical components of this arthroplasty. The current review examines available literature to guide the perioperative care of the reverse total shoulder arthroplasty patient. Recent Findings One of the most important advances for shoulder arthroplasty in recent years has been heightened awareness of various modalities for perioperative pain management. A number of recent studies have focused on the options for regional blockade as a critical tool for postoperative pain relief and the use of either continuous interscalene blocks or single shot blocks are supported. Additional studies are necessary to define the best local anesthetic agent and delivery mechanism to provide appropriate pain relief with a low side effect profile. Summary Management of the patient throughout the perioperative course is a critical component in achieving better patient outcomes delivering high quality patient care. An orthopedic surgery team focused on perioperative management is better positioned to decrease adverse events and improve patient outcomes after reverse total shoulder arthroplasty.

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Ethics of Provider Risk Factor Modification in Total Joint Arthroplasty

Cited by 18 publications

References 29 publications

Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Profound Impact of Insurance Payor and Socioeconomic Status in Total Hip Arthroplasty Outcomes: Results From a High Volume Tertiary Care Center

Ethical Considerations in Total Joint Arthroplasty

Perioperative Management in Reverse Total Shoulder Arthroplasty

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