Reducing Acute Hospitalization Length of Stay After Total Knee Arthroplasty: A Quality Improvement Study

Gleicher, Yehoshua; Siddiqui, Naveed; Mazda, Yusuke; Matelski, John; Backstein, David; Wolfstadt, Jesse

doi:10.1016/j.arth.2020.09.054

Cited by 16 publications

(29 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, reducing the LOS can reduce the probability of cross-infection among patients [ 13 ] and shorten the time of direct contact between patients and doctors, which, especially during epidemics, can reduce the potential risk of disease transmission. Yehoshua Gleicher et al suggested that (1) perioperative peripheral nerve block, (2) prophylactic antiemetic drugs, (3) avoidance of routine preoperative catheterization, and (4) preoperative patient education can effectively shorten the LOS [ 14 ]. Shortening the LOS can also reduce the incidence of deep vein thrombosis [ 15 ], reduce the perioperative blood transfusion rate [ 16 ], motivate patients to perform early functional exercises, and reduce the likelihood of fracture and infection around the prosthesis, enabling the body to adapt to the placement of the prosthesis earlier.…”

Section: Discussionmentioning

confidence: 99%

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

2021

BMC Anesthesiol

View full text Add to dashboard Cite

Background Evidence regarding the relationship between the type of anaesthesia and length of hospital stay is controversial. Therefore, the objective of this research was to investigate whether the type of anaesthesia was independently related to the length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA) after adjusting for other covariates. Methods The present study was a cohort study. A total of 2622 participants underwent total knee arthroplasty (TKA) at a hospital in Singapore from 2013 to 1-1 to 2014-6-30. The target independent variable and the dependent variable were two types of anaesthesia and length of hospital stay, respectively. The covariates included age, BMI, hemoglobin (Hb), length of stay (LOS), duration of surgery, sex, ethnicity, American Society of Anesthesiologist (ASA) Status, smoking, obstructive sleep apnea (OSA), diabetes mellitus (DM), DM on insulin, ischemic heart disease (IHD), congestive cardiac failure (CCF), cerebrovascular accident (CVA), creatinine > 2 mg/dl, day of week of operation. Multivariate linear and logistic regression analyses were performed on the variables that might influence the choice of the two types of anaesthesia and the LOS. This association was then tested by subgroup analysis using hierarchical variables. Results The average age of 2366 selected participants was 66.57 ± 8.23 years old, and approximately 24.18% of them were male. The average LOS of all enrolled patients was 5.37 ± 4.87 days, 5.92 ± 6.20 days for patients receiving general anaesthesia (GA) and 5.09 ± 3.98 days for patients receiving regional anaesthesia (RA), P < 0.05. The results of fully adjusted linear regression showed that GA lasted 0.93 days longer than RA (β = 0.93, 95% CI (0.54, 1.32)), P < 0.05. The results of fully adjusted logistic regression showed that LOS > 6 days was 45% higher for GA than for RA (OR = 1.45, 95% CI (1.15, 1.84)), P < 0.05. Through the subgroup analysis, the results were basically stable and reliable. Conclusion Our study showed that GA increased the length of stay during unilateral TKA compared with RA. This finding needs to be validated in future studies.

show abstract

Section: Discussionmentioning

confidence: 99%

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

2021

BMC Anesthesiol

View full text Add to dashboard Cite

show abstract

“…Early mobilisation could not have been achieved without modifying our anaesthetic and having a dedicated PT in the PACU to assist with patient ambulation and assess discharge readiness. The needs analysis identified the requisite for explicit patient criteria, given that our patient population has complex comorbidities with 65% having an ASA classification 3 or greater 16. Most importantly, there was a clear need to maintain a parallel inpatient pathway for the more complex patients and to establish a communication process for care providers to identify whether an individual patient is a candidate for the inpatient or outpatient pathway.…”

Section: Discussionmentioning

confidence: 99%

“…Our pre-existing inpatient TJA pathway has previously been described and includes a multimodal analgesia protocol and patient education materials 16. The multidisciplinary group decided to complete a needs assessment and pilot cases to identify barriers to the programme.…”

Section: Methodsmentioning

confidence: 99%

“…At our tertiary healthcare centre, 600 primary TJA procedures are performed annually. Using enhanced recovery after surgery protocols and quality improvement (QI) methodologies which are embraced and supported within our institution, we previously reduced inpatient LOS to under 2 days 16. However, our programme has traditionally relied on an inpatient model and had no existing pathway or resources for outpatient surgery, with no TJA surgeries being performed as outpatient prior to the pandemic.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

et al. 2022

Self Cite

View full text Add to dashboard Cite

BackgroundHip and knee total joint arthroplasty (TJA) procedures are two of the most common inpatient surgical procedures worldwide. Outpatient TJA has emerged as a feasible option. COVID-19 caused significant constraints on inpatient surgical resources and contributed to a growing surgical backlog. We present a quality improvement (QI) initiative aimed at adding an outpatient TJA pathway to our pre-existing inpatient TJA programme, with the target of performing 25% of our primary TJA as outpatients.MethodsThis was a QI study at a tertiary level arthroplasty centre. To achieve our aim, a patient-centred needs analysis revealed the need to develop patient selection criteria, perform a specific and tailored anaesthetic, provide patient education and conduct virtual care follow-up. Based on these findings, an outpatient TJA intervention bundle was developed and implemented.ResultsAfter implementing the outpatient pathway, 65 patients were scheduled for outpatient TJA. Fifty-five (84.6%) patients were successfully discharged home on the day of surgery. Successful outpatient TJA accounted for 33.3% of all primary TJAs performed at our intuition throughout the study period. There was excellent adherence to the intervention protocols, with the success hinging on multidisciplinary team and supported QI culture. Thirty-day emergency department visits for inpatient and outpatient TJAs were 8.93% and 6.15%, respectively. No outpatient TJA patients required hospital readmission within 30 days.ConclusionOur study demonstrates that implementation of an outpatient TJA pathway in response to inpatient resource constraints during the COVID-19 pandemic is feasible. The findings of this report will be of interest to surgical centres facing surgical backlog and constraints on inpatient resources during and after the pandemic.

show abstract

“…The impact of Ontario's second wave on inpatient resources has exacerbated the surgical backlog even further. The total joint arthroplasty (TJA) program at Sinai Health in Toronto recently introduced an enhanced recovery after surgery bundle, 2 which has enabled us to pivot quickly to an outpatient TJA program in response to restrictions on inpatient surgery.…”

mentioning

confidence: 99%

Transitioning to outpatient arthroplasty during COVID-19: time to pivot

Gleicher¹,

Peacock²,

Peer

et al. 2021

CMAJ

Self Cite

View full text Add to dashboard Cite

Reducing Acute Hospitalization Length of Stay After Total Knee Arthroplasty: A Quality Improvement Study

Cited by 16 publications

References 43 publications

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

Rapid implementation of an outpatient arthroplasty care pathway: a COVID-19-driven quality improvement initiative

Transitioning to outpatient arthroplasty during COVID-19: time to pivot

Contact Info

Product

Resources

About