Temporal Trends and Predictors of Thirty-Day Readmissions and Emergency Department Visits Following Total Knee Arthroplasty in Ontario Between 2003 and 2016

Ross, Tayler D; Dvorani, Erind; Saskin, Refik; Khoshbin, Amir; Atrey, Amit; Ward, Sarah

doi:10.1016/j.arth.2019.09.015

Cited by 34 publications

(26 citation statements)

References 47 publications

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“…(Petersen et al 2019). In contrast, there are several studies where outpatient procedures are defined as less than 24 hours or less than 2 midnights (Vehmeijer et al 2018, Johnson et al 2020 or with use of nursing care facilities or rehabilitation homes (Cram et al 2018, Ross et al 2020, which may give a false impression of reduced LOS. In this context, a limitation of our study is the lack of detailed information on discharge destination although non-home discharge after fast-track THA and TKA is limited in Denmark and even in patients > 85 years been demonstrated to occur in only about 7% of patients (Pitter et al 2016).…”

Section: Discussionmentioning

confidence: 99%

“… 2018 , Ross et al. 2020 ), which may give a false impression of reduced LOS. In this context, a limitation of our study is the lack of detailed information on discharge destination although non-home discharge after fast-track THA and TKA is limited in Denmark and even in patients > 85 years been demonstrated to occur in only about 7% of patients (Pitter et al.…”

Section: Discussionmentioning

confidence: 99%

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Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

et al. 2020

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Background and purpose — Enhanced recovery programs have reduced length of stay (LOS) after hip and knee arthroplasty (THA/TKA). Although risk factors disposing to prolonged LOS are well documented, there is limited information on the role of weekday of surgery. This study analyzed the role of weekday of surgery and other potential risk factors for LOS > 2 days. Patients and methods — We included 10,576 unselected consecutive procedures between January 2016 and August 2017 within a multicenter fast-track THA/TKA collaboration with prospective collection of preoperative characteristics. We used multiple regression analysis of potential risk factors for LOS > 2 days followed by construction of a simple risk score from 0 to 15 points based on the calculated odds ratios. Results — Mean LOS was 1.9 (SD 1.8) days, with 80% of patients having surgery from Monday to Wednesday. Of these, 17% (95% CI 16–18) had a LOS > 2 days vs. 19% (CI 17–21) in those operated on Thursday and Friday. Patients were scheduled evenly throughout the week regardless of risk of LOS > 2 days and despite the fact that 38% (CI 35–40) of patients with ≥ 6 points (16% of the total population) had a LOS > 2 days compared with 14% (CI 13–14) in those with < 6 points. In these “high-risk” patients, the fraction with LOS > 2 days increased when having surgery on Thursdays or Fridays (43% CI 38–49) compared with Monday to Wednesday (37% CI 34–39). Interpretation — A detailed preoperative risk assessment may be helpful to plan the weekday of surgery in order to decrease LOS and weekend hospitalization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

et al. 2020

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“… 11 – 14 The primary outcome of postprocedural ED visits represents an important health care economic burden and an outcome associated with the quality of treatment. 15 – 17 Theoretically, interventions that improve the quality of care should result in a decreased ADE incidence and reduced ED visits and formed the basis of our hypothesis that the MAPPP app would be effective in reducing ED visits during the 30-day postprocedural period. Emergency department visits were decreased by approximately 50% in the acceptance group versus the rejection group (4.0% vs 8.3%, P = .0205).…”

Section: Discussionmentioning

confidence: 99%

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Spyropoulos

Giannis

Cohen

et al. 2020

Clin Appl Thromb Hemost

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Appropriate perioperative management of patients on chronic oral anticoagulation (OAC)—including warfarin and the direct oral anticoagulants—is a poorly defined yet important clinical issue with potentially severe consequences in the postoperative period. We sought to prospectively evaluate the effect of the Management of Anticoagulation in the Periprocedural Period (MAPPP) mobile app as a clinical decision tool in the management of patients on chronic OAC undergoing elective procedures or surgeries. Between January 1, 2018, and January 31, 2019, 642 patients treated in our health system were included. Eligible patients met the following criteria: age >18 years old, creatinine clearance ≥15 mL/min, and on chronic OAC with adequate information regarding baseline characteristics. Our study outcome was patient’s emergency department (ED) visits within 30 days postprocedure. The MAPPP app was integrated into the electronic health record (EHR), and the end user was free to accept or decline recommended evidence-based perioperative anticoagulation management guidance. Analysis revealed that acceptance was more common in younger patients ( P = .0137), patients on oral anticoagulants other than warfarin ( P < .0001), and patients undergoing increased bleeding risk procedures ( P = .0068). Acceptance of the MAPPP app recommendation was significantly associated with fewer ED visits (acceptance group: 4.0% vs rejection group: 8.3%, P = .0205). Logistic regression showed that intervention acceptance and female gender were significantly associated with fewer—while age ≥80 with more—30-day ED visits. Our findings indicate that newer technologies, such as the MAPPP app, integrated into clinical EHR workflow, can significantly augment evidence-based perioperative anticoagulation management and potentially result in a reduction of adverse outcomes.

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“… 5 10 11 12 13 28) Most of these pathways have adopted screening and optimization strategies based on risk predictors brought out by registry data analysis and retrospective studies. 17 19 20 29) Many studies have reported acceptable complication rates using CCPs, but there are limited studies in which CCPs have been scientifically implemented on a large cohort with RM endpoints comparing their outcomes with the standard of care cohort ( Table 5 ). There is no prospective comparative concurrent cohort trial till date.…”

Section: Discussionmentioning

confidence: 99%

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

et al. 2022

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Background With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. Methods This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. Results TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group ( p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). Conclusions Screening and RM can reduce 90-day complications in patients undergoing TKA.

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Temporal Trends and Predictors of Thirty-Day Readmissions and Emergency Department Visits Following Total Knee Arthroplasty in Ontario Between 2003 and 2016

Cited by 34 publications

References 47 publications

Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

Influence of day of surgery and prediction of LOS > 2 days after fast-track hip and knee replacement

Implementation of the Management of Anticoagulation in the Periprocedural Period App Into an Electronic Health Record: A Prospective Cohort Study

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

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