Medical and Surgical Comanagement after Elective Hip and Knee Arthroplasty

Huddleston, Jeanne M.; Long, Kirsten Hall; Naessens, James M.; Vanness, David J.; Larson, Dirk R.; Trousdale, Robert T.; Plevak, Matt; Cabanela, Miguel E.; Ilstrup, Duane M.; Wachter, Robert M.

doi:10.7326/0003-4819-141-1-200407060-00012

Cited by 233 publications

(205 citation statements)

References 31 publications

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“…One study was excluded after review of the full-text article [19] as no CGA-based intervention was undertaken. We included two randomised controlled trials [20,21] and three before-and-after studies [17,18,22]. Heterogeneity in study design, population, intervention and outcomes precluded meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…1). Six full-text articles were eligible following screening of abstracts [17][18][19][20][21][22]. One study was excluded after review of the full-text article [19] as no CGA-based intervention was undertaken.…”

Section: Resultsmentioning

confidence: 99%

“…One trial examined patients aged over 50 years undergoing various types of elective non-cardiac surgery (ENT, orthopaedics, ophthalmology, gastrointestinal, urological, plastic, neurosurgery, vascular, dental) [21]. The other study included all patients over the age of 18 years undergoing elective orthopaedic procedures: despite the inclusion of younger patients, the mean (SD) ages in the intervention and control groups were 72.6 (10.6) and 73.7 (8.7) years, respectively [20]. Outcome measures included length of stay, cancellations, resource use and postoperative medical complications.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

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The impact of pre‐operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review

et al. 2013

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SummaryComprehensive geriatric assessment is an established clinical approach. It reduces mortality and improves the physical wellbeing of older people in the community or hospitalised for medical reasons. Pre-operative comprehensive geriatric assessment seems a plausible method for reducing adverse postoperative outcomes. The objectives of this systematic review and narrative synthesis are to describe how pre-operative comprehensive geriatric assessment has been used in surgical patients and to examine the impact of comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery. We searched MEDLINE, EMBASE and Web of Science from 1980 to 2013 (week 26). We included five studies: two randomised controlled trials and three before-and-after intervention quasi-experimental studies. Patient populations, interventions and outcome measures varied between studies. Both the randomised trials showed benefit on postoperative outcomes, including medical complications. Two of the before-and-after studies reported a positive impact on postoperative length of stay and other outcomes. The heterogeneity of study methods, populations, interventions and outcomes precluded meta-analysis. Based on this narrative synthesis, pre-operative comprehensive geriatric assessment is likely to have a positive impact on postoperative outcomes in older patients undergoing elective surgery, but further definitive research is required. Clinical services providing pre-operative comprehensive geriatric assessment for older surgical patients should be considered. An increasing proportion of the ageing population is undergoing surgery [1]. Despite the benefits of surgery seen in this population, the rate of adverse postoperative outcomes increases with age [2]. Postoperative complications are predominantly medical rather than surgical [3], and their increased rate is associated with physiological age [4], multimorbidity [5,6] and geriatric syndromes, including frailty [7], sarcopenia [8] and delirium [9]. Although adverse postoperative outcomes and the risk factors for developing these are well described in older surgical patients [2], a national UK report has highlighted deficiencies in the care provided to this patient population [10]. Furthermore, pre-operative assessment has not been adapted to identify and modify these geriatric syndromes and multi-morbidity 8

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Randomised Controlled Trialsmentioning

confidence: 99%

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The impact of pre‐operative comprehensive geriatric assessment on postoperative outcomes in older patients undergoing scheduled surgery: a systematic review

et al. 2013

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“…Huddleston demostró una reducción en las complicaciones post operatorias en pacientes ortopédicos manejados por hospitalistas (p < 0,01) 41 . Phy y Roy encontraron que pacientes ortopédicos co-manejados por hospitalistas tuvieron una latencia menor a cirugía (p < 0,001 y p = 0,004) 42,43 , y estadías hospitalarias más cortas que los pacientes manejados sin hospitalistas (p < 0,001) 42 .…”

Section: Manejo Peri-operatoriounclassified

Medicina hospitalaria a 15 años de su implementación: ¿Cuáles son los potenciales beneficios en nuestro medio?

Eymin

Jaffer

2013

Rev. méd. Chile

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L a medicina hospitalaria es una disciplina dedicada a entregar cuidados médicos exhaustivos a pacientes hospitalizados, a la vez que se encarga de la docencia clínica, investigación y liderazgo en el campo de la medicina interna. A diferencia del internista general, el hospitalista brinda una atención completa y oportuna de todas las necesidades del paciente, incluyendo diagnóstico, tratamiento y procedimientos de variada índole, incorpora técnicas de mejoramiento de procesos y de calidad, colabora, comunica y coordina los cuidados prestados por los diferentes profesionales de la salud, hace uso eficiente de los recursos hospitalarios y se encarga de que las transiciones del paciente a través del hospital y entre este y su domicilio sea segura 1 . Sus competencias son variadas, y se pueden agrupar en condiciones clínicas, procedimientos y en los sistemas al interior del hospital (seguridad de pacientes, docencia, mejoría de procesos). Esta especialidad, descrita en Estados Unidos de Norteamérica en 1996, ha alcanzado un desarrollo y crecimiento sin precedentes en ese país, superando el crecimiento de todas las especialidades de la medicina 2-4 , crecimiento que coincide con el cambio en la forma de reembolso de las prestaciones médicas 5 , y con el creciente aumento del interés por mejorar la seguridad en los hospitales después de la publicación "To err is human" (1999) en la cual se describe que entre 44.000 y 98.000 personas mueren cada año en Estados Unidos de Norteamérica producto de eventos adversos potencialmente prevenibles 6 . Antiguamente el pago de prestaciones de salud en Estados Unidos de Norteamérica se hacía por servicios prestados (Fee for service), sin embargo, actualmente se hace en relación a un determinado grupo de diagnósticos relacionados, en el cual todas las condiciones codificadas bajo un mismo grupo son reembolsadas con un monto fijo independientemente del curso hospitalario del paciente 7 . Así, si los hospitales acortan las estadías y realizan menos exámenes, el ahorro para el hospital es mayor. Además, a partir del 2010 el CMS (Entidad pagadora de prestaciones en salud) comenzó a negar el reembolso asociado a reingresos a 30 días en pacientes con neumonía, insuficiencia cardiaca,

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“…And surgical patients are under the same value pressures as medical patients, with increasing public reporting of quality processes and outcomes and new pay for performance programs coming on line. Although the evidence of benefit is mixed, [6][7][8] 6 How does the money flow? Most hospitalist programs receive hospital support, but it is legitimate to wonder whether the specialists, particularly surgeons, should chip in to support the program, particularly if they continue to collect a global case rate that was predicated on their provision of pre-and post-operative care.…”

Section: Comanagement Of Nonmedical Patientsmentioning

confidence: 99%