Rapid Recovery Total Joint Arthroplasty is Safe, Efficient, and Cost-Effective in the Veterans Administration Setting

Yanik, John M.; Bedard, Nicholas A.; Hanley, Jessica M.; Otero, Jesse E.; Callaghan, John J.; Marsh, J. Lawrence

doi:10.1016/j.arth.2018.07.004

Cited by 39 publications

(43 citation statements)

References 24 publications

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“…Unicompartmental Knee Arthroplasty (UKA) performed under an accelerated pathway including minimally invasive surgery, discharge the same day of surgery, and no inpatient physiotherapy reported earlier improvements in knee motion in comparison to a conventional, more invasive approach, equal safety provided [41]. Similar findings were reported by a retrospective observational study on TJAs in a Veteran setting, which concludes how these protocols are essential to support the "transition into an era of value-based arthroplasty" [42].…”

Section: Efficacysupporting

confidence: 55%

“…Accelerated perioperative care and rehabilitation after hip and knee arthroplasty demonstrated good results under different settings and circumstances [42], which provides preliminary evidence of efficiency to investigate the specific degree of effectiveness.…”

Section: Efficacymentioning

confidence: 85%

“…Value is given by healthcare outcomes per dollar spent [43]. Accelerated pathways demonstrated to reduce the cost of arthroplasty up to 1 year-postoperatively [44], resulting cost-effective in different settings [42,45].…”

Section: Economic and Financial Impactmentioning

confidence: 99%

See 2 more Smart Citations

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

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Background: The number of patients undergoing joint arthroplasty is increasing worldwide. An Enhanced Recovery After Surgery (ERAS) pathway for hip and knee arthroplasty was introduced in an Italian high-volume research hospital in March 2018. Methods: The aim of this mixed methods observational study is to perform a health technology assessment (HTA) of the ERAS pathway, considering 938 procedures performed after its implementation, by means of a hospitalbased approach derived from the EUnetHTA (European Network for Health Technology Assessment) Core Model. The assessment process is based on dimensions of general relevance, safety, efficacy, effectiveness, economic and financial impact, equity, legal aspects, social and ethical impact, and organizational impact. A narrative review of the literature helped to identify general relevance, safety and efficacy factors, and a set of relevant sub-dimensions submitted to the evaluation of the professionals who use the technology through a 7-item Likert Scale. The economic and financial impact of the ERAS pathway on the hospital budget was supported by quantitative data collected from internal or national registries, employing economic modelling strategies to identify the amount of resources required to implement it. Results: The relevance of technology under assessment is recognized worldwide. A number of studies show accelerated pathways to dominate conventional approaches on pain reduction, functional recovery, prevention of complications, improvements in tolerability and quality of life, including fragile or vulnerable patients. Qualitative surveys on clinical and functional outcomes confirm most of these benefits. The ERAS pathway is associated with a reduced length of stay in comparison with the Italian hospitalization average for the same procedures, despite the poor spread of the pathway within the country may generate postcode inequalities. The economic analyses show how the resources invested in training activities are largely depreciated by benefits once the technology is permanently introduced, which may generate hospital cost savings of up to 2054,123.44 € per year. Conclusions: Galeazzi Hospital's ERAS pathway for hip and knee arthroplasty results preferable to traditional approaches following most of the HTA dimensions, and offers room for further improvement. The more comparable practices are shared, the before this potential improvement can be identified and addressed.

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Section: Efficacysupporting

confidence: 55%

Section: Efficacymentioning

confidence: 85%

See 1 more Smart Citation

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Vanni

Foglia

Pennestrì

et al. 2020

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Studies show that THA is shifting to the outpatient setting worldwide, with estimates showing that by 2026, more than half of THAs in the United States will be performed as an outpatient procedure [3,4]. This transition has been enabled by various factors including the rise in multidisciplinary care coordination, standardization of perioperative protocols, and development of rapid rehabilitation protocols [5][6][7]. As the main concern of outpatient THA is patient safety, several studies have investigated immediate and delayed postoperative complications, with a systematic review nding equivalent complications between outpatient and inpatient arthroplasty [8].…”

Section: Introductionmentioning

confidence: 99%

Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Rosinsky

Chen

Yelton

et al. 2020

Preprint

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Background: The transition to outpatient-based surgery is a major development occurring in recent years in the field of total hip arthroplasty (THA). The effect of this transition on patient reported outcomes (PROs) is still not well established. The purpose of the current study was to compare patients undergoing inpatient THA (iTHA) to patients undergoing outpatient THA (oTHA) regarding (1) perioperative variables including: surgical time, blood loss, and length of stay (2) 90-day complication rates and unplanned emergency room or office visits (3) 2-year PROs including: modified Harris hip score (mHHS), Harris hip score (HHS), forgotten joint score (FJS), pain, and satisfaction, as well as quality of live measures. Methods: The XXX registry was analyzed for patients undergoing THA between July 2014 and April 2016. The first 100 patients undergoing oTHA were selected and matched to 100 patients undergoing iTHA via propensity matching based on the following variables: age, sex, body mass index (BMI), Charlson comorbidity index (CCI), and smoking status. The primary outcomes were PROs at two years post-operatively. The secondary outcomes were perioperative surgical variables, 90-day complication rates, and unplanned emergency and clinic visits. Results: After exclusions, 91 patients remained in each group and were compared. The oTHA group showed improved 2-year PROs with regard to mHHS (91.5 vs. 86.2; P=0.02), HHS (92.3 vs. 87.4; P=0.02), and pain (1.0 vs. 1.5; P=0.04). The oTHA group had an average length of stay of 6.8 hours compared to 43.2 hours for the iTHA group (P<0.001). There were no significant differences between the groups regarding readmissions, emergency room visits, and unplanned clinic visits. Complications and revision rates were similar in both groups. Conclusion: In appropriately selected, younger patients, oTHA can achieve improved postoperative 2-year PROs compared to iTHA. We found no differences regarding postoperative short-term complications or two-year revision rates, and no differences in unplanned office visits or readmissions.

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“…There was not special operation bed in our Hospital. All operations were performed by conventional operation bed and conventional femoral stem in primary THA, which had the bene ts of low cost and equipment, convenient to operation [11][12][13]. The postoperative outcome was satisfactory in DAA THA, but the femoral fracture rate was higher than posterior approach.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

Sun

Yin

et al. 2020

Preprint

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Objective: In order to provide guideline to operation and reduce the incidence of fractures, this study analyze the relationship between femoral fractures and related factors in direct anterior approach (DAA) total hip arthroplasty (THA) in lateral decubitus position. Method: A consecutive retrospective series of 273 THA by DAA in lateral decubitus position were analyzed. The surgery were performed by the same surgeon with conventional operation bed and femoral stem. The correlations between incidence of fractures with gender, age, body mass index (BMI), height, osteoporosis, anterior superior iliac spine-greater trochanter distance (ASIS-GTD), and hip-joint diseases were analyzed by univariate analysis and logistic regression analysis. Results: Among all hip arthroplasty, 34 cases had femoral fractures, including 29 greater trochanter fractures, 4 proximal femoral splits and 1 femoral perforation. The incidence of fractures was 13.03%. Univariate analysis: the discrepancies in incidence of fractures among genders, BMIs and age were not significant different; osteoporosis caused an increase of fractures; the incidence of fractures declined as height, ASIS-GTD increased; The incidence of femoral neck fracture and osteonecrosis of femoral head was lower than others. Logistic regression results: there was a significant correlation between osteoporosis, ASIS-GTD and fractures. Patients with osteoporosis had a high possibility of fractures (OR=2.353); the possibility of fractures decreased with an upward ASIS-GTD(OR=0.939). Conclusion: The lateral decubitus DAA THA can be successfully performed using conventional operation bed and stem, which saved medical resources effectively. Osteoporosis and ASIS-GTD were independent risk factors for femoral fractures; Short stature, inflammatory arthroses were relatively risk factors.

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Rapid Recovery Total Joint Arthroplasty is Safe, Efficient, and Cost-Effective in the Veterans Administration Setting

Cited by 39 publications

References 24 publications

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Introducing enhanced recovery after surgery in a high-volume orthopaedic hospital: a health technology assessment

Outpatient vs. Inpatient Hip Arthroplasty: A Matched Case-Control Study on 90-Day Complication Rate and 2-Year Patient Reported Outcomes

Risk Factors of Femoral Fractures in Lateral Decubitus Direct Anterior Approach Total Hip Arthroplasty Using Conventional Stem: A Retrospective Analysis

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