Same-Day Outpatient Lower-Extremity Joint Replacement

Barra, Matthew F; Kaplan, Nathan; Balkissoon, Rishi; Drinkwater, Christopher; Ginnetti, John G; Ricciardi, Benjamin F.

doi:10.2106/jbjs.rvw.22.00036

Cited by 3 publications

(3 citation statements)

References 135 publications

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“…1,2 TJR care delivery is undergoing dynamic changes, with the growth of bundled payment models as well as the shift to outpatient surgery. 3,4 Preoperative patient education is a potentially important element for improving the quality of care in this dynamic landscape 5,6 and is recommended as part of an evidence-based enhanced recovery pathway. 7,8 A few studies have shown components of preoperative TJR education to be related to improvement in specific perioperative metrics such as length of stay, episode costs, preoperative anxiety or expectations.…”

Section: Introductionmentioning

confidence: 99%

“…Total joint replacement (TJR) has been a focus of health care reform given the growing volume and related costs to the health system 1,2 . TJR care delivery is undergoing dynamic changes, with the growth of bundled payment models as well as the shift to outpatient surgery 3,4 . Preoperative patient education is a potentially important element for improving the quality of care in this dynamic landscape 5,6 and is recommended as part of an evidence‐based enhanced recovery pathway 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Herrera

Stern

Russo

et al. 2023

Evaluation Clinical Practice

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RationalePreoperative patient education through ‘joint class’ has potential to improve quality of care for total joint replacement (TJR). However, no formal guidance exists regarding curriculum content, potentially resulting in inter‐institutional variation.ObjectiveWe aimed to (a) synthesize curriculum components of ‘joint classes’ across high‐volume institutions and (b) develop a preliminary theory of change model for development and evaluation guided by the existing curricula and related literature.MethodsWe reviewed ‘joint class’ curricula from the websites of the 10 highest‐volume TJR centres (by average annual 2017–2019 volume) that publicly disclosed this information. Two reviewers qualitatively compared available content and noted common categories, which were synthesized into key domains across institutions. We then reviewed the PubMed database for literature on pre‐TJR patient education and education needs in the past 10 years. Drawing on our curriculum synthesis and related literature, we proposed a theory of change model: hypothesized mechanisms through which ‘joint class’ confers benefits to patients and health systems.ResultsWe identified 30 categories in our review of existing class content, which we synthesized into seven key domains: (I) Practical Elements, (II) Logistics, (III) Medical Information, (IV) Modifiable Risk Factors, (V) Expected Outcomes, (VI) Patient Role in Recovery and (VII) Enhanced Education. Variation across institutions was noted. Our preliminary model based on the curriculum synthesis and related literature on the impact of ‘joint class’ includes three levels: (1) Practical Elements (‘joint class’ accessibility and information quality), (2) Class Goals (increased health literacy, increased adherence, risk mitigation, realistic expectations, and reduced anxiety) and (3) Target Outcomes (improved clinical outcomes, positive patient experience and increased patient satisfaction).ConclusionOur synthesis identified core common topics included in pre‐TJR education but also highlighted variation across institutions, supporting opportunities for standardization. Clinicians and researchers can use our preliminary model to systematically develop and evaluate ‘joint classes,’ with the goal of establishing a standard of care for TJR preoperative education.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Herrera

Stern

Russo

et al. 2023

Evaluation Clinical Practice

View full text Add to dashboard Cite

show abstract

“…3-9 The safety and efficacy of SDD TJA has been established in the intervening 15 years 10-13 with demonstrated reliance on the selection of appropriate patients, avoidance of intraoperative complications, and a clinical team skilled in protocols designed to minimize complications and maximize recovery. 14-17 Consequently, payers have begun to direct qualifying cases to ambulatory surgery center (ASC). Nonetheless, failure to achieve planned SDD for primary TJA occurs in as many as 7% to 49% of patients in the United States.…”

mentioning

confidence: 99%

Predictors of Failure to Achieve Planned Same-Day Discharge after Primary Total Joint Arthroplasty: a Multivariable Analysis of Perioperative Risk Factors

Foley,

Ghosh,

Ziemba-Davis

et al. 2023

J Am Acad Orthop Surg

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Introduction: Failure to achieve planned same-day discharge (SDD) primary total joint arthroplasty (TJA) occurs in as many as 7% to 49% of patients in the United States. This study evaluated the association between 43 perioperative risk factors and SDD failure rates. Methods: A retrospective analysis of prospectively collected data from 466 primary TJAs with planned SDD to home was performed. Surgeries were performed at an academic tertiary care center comprising a hospital facility and a stand-alone ambulatory surgery center (ASC) on the same campus. Factors associated with failed SDD were identified using a multivariable analysis. Results: Only one of 316 (0.3%) patients who underwent surgery in the ASC failed planned SDD (P < 0.001) compared with 33.3% of 150 patients who underwent surgery in the hospital. The ASC failure was because of pain that interfered with physical therapy. Sixty-two percent (n = 31) of hospital failures were attributed to medical complications, 24% (n = 12) to physical therapy clearance, 8% (n = 4) to not being seen by internal medicine or therapy on the day of surgery, and 6% (n = 3) to unknown causes. Failure was increased in patients with preoperative anemia (P = 0.003), nonwhite patients (P = 0.002), patients taking depression/anxiety medication (P = 0.015), and for every 10-morphine milligram equivalent increase in opioids consumed per hour in the postacute care unit (P = 0.030). Discussion: Risk stratification methods used to allocate patients to ASC versus hospital outpatient TJA surgery predicted SDD success. Most failures were secondary to medical causes. The findings of this study may be used to improve perioperative protocols enabling the safe planning and selection of patients for SDD pathways.

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Site of Service Disparities Exist for Total Joint Arthroplasty

Truong,

Leversedge,

Zhuang

et al. 2024

Orthopedics

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Background: The rate of outpatient total joint arthroplasty procedures, including those performed at ambulatory surgical centers (ASCs) and hospital outpatient departments, is increasing. The purpose of this study was to analyze if type of insurance is associated with site of service (inpatient vs outpatient) for total joint arthroplasty and adverse outcomes. Materials and Methods: We identified patients undergoing unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), or total hip arthroplasty (THA) using Current Procedural Terminology codes in a national administrative claims database. Eligible patients were stratified by type of insurance (Medicaid, Medicare, private). The primary outcome was site of service. Secondary outcomes included general complications, procedural complications, and revision procedures. We evaluated the associations using adjusted multivariable logistic regression models. Results: We identified 951,568 patients for analysis; 46,703 (4.9%) patients underwent UKA, 607,221 (63.8%) underwent TKA, and 297,644 (31.3%) underwent THA. Overall, 9.6% of procedures were outpatient. Patients with Medicaid were less likely than privately insured patients to receive outpatient UKA or THA (UKA: odds ratio [OR], 0.729 [95% CI, 0.640–0.829]; THA: OR, 0.625 [95% CI, 0.557–0.702]) but more likely than patients with Medicare to receive outpatient TKA or THA (TKA: OR, 1.391 [95% CI, 1.315–1.472]; THA: OR, 1.327 [95% CI, 1.166–1.506]). Patients with Medicaid were more likely to experience complications and revision procedures. Conclusion: Differences in site of service and complication rates following hip and knee arthroplasty exist based on type of insurance, suggesting a disparity in care. Further exploration of drivers of this disparity is warranted and can inform interventions (eg, progressive value-based payments) to support equity in orthopedic services. [ Orthopedics . 202x;4x(x):xx–xx.]

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Same-Day Outpatient Lower-Extremity Joint Replacement

Cited by 3 publications

References 135 publications

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Synthesis of ‘joint class’ curricula at high volume joint replacement centres and a preliminary model for development and evaluation

Predictors of Failure to Achieve Planned Same-Day Discharge after Primary Total Joint Arthroplasty: a Multivariable Analysis of Perioperative Risk Factors

Site of Service Disparities Exist for Total Joint Arthroplasty

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