Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes

Abstract

AIM:To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home (PSH) program. METHODS:A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were preoperatively stratified based on specific procedure performed, age, gender, body mass index (BMI), American Society of Anesthesiologists Physical Classification System (ASA) score, and Charleston Comorbidity Index (CCI) score. The primary outcome criterion was hospital length of stay (LOS). Secondary criteria including operative room (OR) duration, trans- RESULTS:A total of 337 patients, 200 in the TKA cohort and 137 in the THA cohort, were eligible for the study. Nearly two-third of patients were female. Patient age averaged 64 years and preoperative BMI averaged 29 kg/m 2 . The majority of patients were ASA score Ⅲ and CCI score 0. After analysis, ASA score was the only variable predictive for LOS (P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d. ASA score was also the only variable predictive for readmission rate (P = 0.0332). BMI was the only variable predictive for PACU duration (P = 0.0136). Specific procedure performed, age, gender, and CCI score were not predictive for any of the outcome criteria. OR duration, transfusion rate, postoperative complications or discharge disposition were not significantly associated with any of the predictor variables. CONCLUSION:The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.

Does Discharge Destination Matter after Total Knee Arthroplasty? A Single-Institution Korean Experience

“…In our study, we did not find any difference in age and sex distribution between the two groups. Similar to our findings, two retrospective studies on total knee and hip arthroplasties also did not find any differences in age and sex distributions among the discharge destination groups 15 , 23) . Like most of the previous studies, our study revealed that among the patients with extended hospital stay, more were discharged to an ECF than to home.…”

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty

“…A novel form of defined clinical pathway, called a Perioperative Surgical Home (PSH), has recently been described and implemented as a patient-centered model to improve healthcare delivery and reduce cost [31][32][33][34]. The PSH is a multidisciplinary rapid recovery pathway comanaged by orthopedic and anesthesia services.…”

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

“…Their group found an increased ASA score was the only factor that contributed to an increased LOS and there was a higher readmission rate for these patients. There was no correlation with age, gender, procedure, or Charlson comorbidiy index (CCI) [30].…”