Perioperative population management for primary hip arthroplasty reduces hospital and postacute care utilization while maintaining or improving care quality

Schubert, Armin; Patterson, Murray; Sumrall, William D.; Broussard, David M.; Dias, D.; Aboalfaraj, Ahmad; Thomas, Leslie; Bergeron, Beau; Brandon, Patricia; Shum, Lucas; Ravipati, Lakshmi N. Prasad; Chimento, George

doi:10.1016/j.jclinane.2020.110072

Cited by 4 publications

(6 citation statements)

References 29 publications

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“…The most common CCSRs, which cumulatively accounted for just over half of the increase in the MS-DRG weighting factor, in descending order of the point estimates, were spine fusion, heart valve surgery, colectomy, pulmonary resection, coronary artery bypass graft, and hip and knee arthroplasty (Table 3). These CCSRs include the surgical procedures commonly targeted for interventions to reduce complications [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], confirming the face validity of our method of using the MS-DRG weighting factor to measure incremental societal costs of complications. The impact of each additional case with an escalation in the MS-DRG differed greatly among the CCSRs.…”

Section: Percentile Shares For Ccsrs and The Causative Diagnoses Amon...mentioning

confidence: 53%

“…Efforts to validate the cost-effectiveness of such expansion of anaesthesiologists' role outside the operating room proper have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. This observation should not be construed as a criticism but rather reflects the complexity of PSH implementation within organizations and the relatively small numbers of surgeons within each surgical subspecialty at most individual hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

Epstein,

Dexter,

Dexter

et al. 2024

Cureus

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Introduction There is an expanding role for anesthesiologists in the preoperative optimization and postoperative management of patients, often in the context of a so-called perioperative surgical home. Such efforts typically include enhanced recovery after surgery (ERAS) protocols and often an anesthesiologist-led team for perioperative management. Studies of the cost-effectiveness of such approaches have generally been conducted at single institutions, with most patients cared for by small numbers of surgeons. This limitation creates generalizability issues as to whether improvement was related mostly to organizational culture or the studied surgeons' practices (non-generalizable) versus the procedures (generalizable). We studied whether other organizations can rely on achieving similar benefits following the adoption of a studied process improvement strategy at a single institution. Methods All patients undergoing elective major therapeutic inpatient surgery discharged between October 2015 and June 2022 at non-federal hospitals in the state of Florida were included. For each discharge, the United States Medicare Severity Diagnosis-Related Group (MS-DRG) weighting factor (i.e., the multiplier for the hospital’s base rate for admissions that determines reimbursement) and the Clinical Classification Software Refined (CCSR) code for the principal procedure were determined at admission and discharge from the state's inpatient healthcare database based on the diagnoses present at those time points. An increase in the weighting factor from admission to discharge represents societal costs from perioperative complications. Statewide, by hospital, and by surgeon, we calculated the total increase for each CCSR's weighting factor. Our primary hypothesis was that surgeon variability would be statistically greater than CCSR variability but that the incremental effect would be <5%. If CCSR and surgeon variability were comparable, this would be supportive of generalizability. In contrast, if there were a predominant effect related to the surgeon, results from one institution might not be applicable to others. Results Among the 1,482,344 discharges studied, the pooled (N=7 years) contributions to MS-DRG weighting factor increases from the upper 20% of surgeons were 2.8% more than from the upper 20% of CCSRs (95% CI 1.9%-3.9%, p =0.0006). Those CCSRs accounted for 85.5% (95% CI 79.4%-91.7%, p <0.0001) of the total increase in the MS-DRG weighting factor. The average contribution of the top two surgeons at each hospital to that hospital's increase in the weighting factor ranged among CCSRs from 68% to 97%. The median and 75th percentile of surgeons performing at least 10% of the total number of cases at each hospital was similar to those values for the contributions to the increases in the MS-DRG weighting factor, median 2.0 to 3.0, and 75th percentile 1.75 to 4.0. Conclusions Because variability among ...

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Section: Percentile Shares For Ccsrs and The Causative Diagnoses Amon...mentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

Epstein,

Dexter,

Dexter

et al. 2024

Cureus

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“…Standardized care pathways in TJA have been shown to optimize quality and cost [ 3 , 4 ]. However, there is surgeon variation in the use of routine pathologic examination of femoral head specimens obtained during THA.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, THA care delivery processes have significant implications on quality and cost for the health-care system. There is current evidence demonstrating a standardized process improves both quality and cost of total joint arthroplasty (TJA) [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons

Nandi¹,

Parvızı²,

Adelani³

et al. 2023

Arthroplasty Today

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“…All these factors have been shown to reduce short-term complications and readmission rates. 29,35–37 Because the NSQIP database used CPT codes to record surgical details, we were unable to differentiate between computer navigation and robotic THA. Notably, not all surgeons may include a secondary CPT code for intraoperative technology when submitting procedure codes to the NSQIP database.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty

Simcox

Singh

Oakley

et al. 2022

J Am Acad Orthop Surg

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Introduction: Although technology-assisted total hip arthroplasty (TA-THA) may improve implant positioning, it remains unknown whether TA-THA confers improved clinical outcomes. We sought to examine national TA-THA utilization trends and compare clinical outcomes between TA-THA and unassisted THA (U-THA). Methods: Patients who underwent primary, elective THA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Demographic, perioperative, and 30-day outcomes were queried and collected. Patients were stratified based on whether they underwent TA-THA, which included computer navigation or robotics, and U-THA. Propensity score matching paired patients undergoing TA-THA or U-THA on a 1:1 basis. Results: Of the 238,755 THA patients, 3,149 cases (1.3%) were done using TA-THA. Comparing the unmatched TA-THA and U-THA groups, race distribution (P , 0.001) and baseline functional status (P , 0.001) differed. Propensity score matching yielded 2,335 TA-THA and U-THA pairs. Perioperatively, the TA-THA cohort had longer mean surgical times (101.0 6 34.0 versus 91.9 6 38.8 minutes, P , 0.001), but lower transfusion rates (5.7% versus 7.8%, P = 0.005). As compared with the U-THA group, the TA-THA group had a shorter mean hospital length of stay (2.0 6 1.1 versus 2.5 6 2.0 days, P , 0.001) and a higher proportion of patients discharged home (85.8% versus 75.7%, P , 0.001). Notably, the TA-THA cohort had higher readmission rates (3.8% versus 2.4%, P , 0.001). Major complication and revision surgery rates did not markedly differ between groups. Discussion: TA-THA utilization rates remain low among orthopaedic surgeons. As compared with U-THA, TA-THA yield mixed perioperative and 30-day outcomes. Surgeons must consider the clinical benefits and drawbacks of TA-THA when determining the proper surgical

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Perioperative population management for primary hip arthroplasty reduces hospital and postacute care utilization while maintaining or improving care quality

Cited by 4 publications

References 29 publications

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

Incremental Societal Costs of Perioperative Complications Following Adult Elective Inpatient Major Therapeutic Surgery in the State of Florida: A Seven-Year Retrospective Epidemiological Analysis

Routine Pathologic Examination of the Femoral Head in Total Hip Arthroplasty: A Survey Study of the American Association of Hip and Knee Surgeons

Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty

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