The transition of total elbow arthroplasty into the outpatient theater

Pasternack, Jordan B.; Mahmood, Bilal; Martins, Adriano S.; Choueka, Jack

doi:10.1016/j.jses.2019.10.004

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…From a resource utilization standpoint, LOS variation impacts the ability to offer elective and nonelective services to additional patients, while also fiscally creating burdens for services with fixed reimbursement schedules, regardless of the numbers of hospitalization days [2]. Attempts to transition appropriate elective surgical procedures from hospital admission status to same day surgery have been moderately successful from the perspectives of both patients and healthcare delivery systems [3][4][5]. Unfortunately, a significant proportion of elective surgeries, especially those involving orthopedic or cancer care, still require some form of inpatient hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures

Cifarelli

McMichael

Forman

et al. 2021

Cureus

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BackgroundHospital length of stay (LOS) remains an important, albeit nonspecific, metric in the analysis of surgical services. Modifiable factors to reduce LOS are few in number and the ability to practically take action is limited. Surgical scheduling of elective cases remains an important task in optimizing workflow and may impact the post-surgical LOS. MethodsRetrospective data from a single tertiary care academic institution were analyzed from elective adult surgical cases performed from 2017 through 2019. Emergent or urgent add-on cases were excluded. Variables included primary procedure, age, diabetes status, American Society of Anesthesiologists (ASA) class, and surgical start time. Analysis of the median LOS following surgery was performed using Mann-Whitney tests and Cox hazards model. Matched-cohort analysis of mean total hospitalization costs was performed using the Student's t-test. Results9,258 patients were analyzed across five surgical service lines, of which 777 patients had surgical start time after 3 PM. The median LOS for the after 3 PM group was 1 day longer than the before 3 PM start time cohort (3.0 vs 2.1, p < 0.001). Service line analysis revealed increased LOS for Orthopedics and Neurosurgery (3.0 vs 1.9, p < 0.001; 3.0 vs 2.0, p < 0.05). Multivariate analysis confirmed that start time before 3 PM predicted shorter LOS (HR = 1.214, 1.126-1.309; p < 0.001). Case-matched cost analysis for frequently performed orthopedic and neurosurgical cases with an after 3 PM start time failed to demonstrate a significant difference in total hospital charges. ConclusionOptimization of surgical services scheduling to increase the proportion of elective surgical cases started before 3 PM has the potential to decrease post-surgical LOS for adult patients undergoing Orthopedic or Neurosurgical procedures.

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Section: Introductionmentioning

confidence: 99%

Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures

Cifarelli

McMichael

Forman

et al. 2021

Cureus

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“…More recently, Pasternack et al conducted a retrospective review of both inpatient and outpatient TEA in the American College of Surgeons National Surgical Quality Program database. 13 The authors reported a lower 30-day complication rate among outpatients, although the difference was not significant. We evaluated the same complications and identified a significant difference in complication rates within the 90-day period.…”

Section: Discussionmentioning

confidence: 88%

Utilization, Complications, and Costs of Inpatient versus Outpatient Total Elbow Arthroplasty

Baxter

Davis

Chen

et al. 2021

Hand (New York, N,Y.)

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Background Although total hip and knee arthroplasty have largely moved to the outpatient setting, total elbow arthroplasty (TEA) remains a predominantly inpatient procedure. Currently, evidence on the safety and potential cost savings of outpatient TEA is limited. Therefore, we aimed to compare the costs and complications associated with performing TEA in the inpatient versus outpatient setting. Methods We identified patients who received elective TEA using the Truven Health MarketScan database. Outcomes of interest were 90-day complication rate, readmission rate, and procedure costs in the inpatient and outpatient settings. We used propensity score matching and logistic regression analysis to assess how patient comorbidities and surgical setting influenced complications and readmission rates. The median cost per patient was compared using the Mann-Whitney U test. Results We identified 307 outpatient and 414 inpatient TEA procedures over a 9-year period. Elixhauser comorbidity scores were higher for the inpatient cohort. The incidence of surgical complications was significantly higher in the inpatient than the outpatient cohort (27% vs 9%). The odds of 90-day readmissions were similar in the 2 groups (37% vs 25%). In terms of cost, the median inpatient TEA was more expensive than outpatient TEA ($26 817 vs $18 412). However, the median cost for occupational therapy within 90 days of surgery was higher for outpatient TEA patients ($687 vs $571). Conclusions The results of this study demonstrate that surgeons can consider a transition toward outpatient TEA for patients without significant comorbidities, as this will substantially reduce health care costs.

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“…Using the NSQIP database, other studies have reported similar short-term complication rates of 12% and reoperation rates of 2.4% following primary TEA. 28,30,31 In the context of studies with longer-term follow-up at 10 years, the overall complication and revision rates reported in those studies were 16.3% and 14.6%. 26 In our study, blood transfusion complications (4%), return to the operating room (3.2%), and wound dehiscence (2.4%) were the most common complications.…”

Section: Discussionmentioning

confidence: 99%

“…Although prior literature has described utilization trends and complication rates for primary and revision TEA broadly, the influence of trainee participation during these procedures is limited. [27][28][29][30][31][32][33][34][35][36][37] In light of a lack of evaluation regarding resident participation during TEA procedures, we sought to use a national surgical database to answer our primary research questions: (1) does resident participation increase shortterm complication risk and surgical complications following TEA and (2) does resident participation have an opportunity cost with regard to increased operative times? To accomplish this, we utilized a national surgical database to compare TEA cases with and without resident participation.…”

Section: Introductionmentioning

confidence: 99%

Total elbow arthroplasty cases involving orthopaedic residents do not affect short-term postoperative complications

Gordon

Malik

2021

Shoulder & Elbow

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Background Impact of resident participation on short-term postoperative outcomes after total elbow arthroplasty has not been studied. The aim was to investigate whether resident participation affects postoperative complication rates, operative time, and length of stay. Methods The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2006 to 2012 for patients undergoing total elbow arthroplasty. A 1:1 propensity score match was performed to match resident cases to attending-only cases. Comorbidities, surgical time, and short-term (30-day) postoperative complications were compared between groups. Multivariate Poisson regression was used to compare the rates of postoperative adverse events between groups. Results After propensity score match, 124 cases (50% with resident participation) were included. Adverse event rate after surgery was 18.5%. On multivariate analysis, there were no significant differences between attending-only cases and resident involved cases, with regards to short-term major complications, minor complications, or any complications (all p > 0.071). Total operative time was similar between cohorts (149.16 vs. 165.66 min; p = 0.157). No difference was observed in the length of hospital stay (2.95 vs. 2.6 days), p = 0.399. Discussion Resident participation during total elbow arthroplasty is not associated with increased risk for short-term medical or surgical postoperative complications or operative efficiency.

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The transition of total elbow arthroplasty into the outpatient theater

Cited by 7 publications

References 23 publications

Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures

Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures

Utilization, Complications, and Costs of Inpatient versus Outpatient Total Elbow Arthroplasty

Total elbow arthroplasty cases involving orthopaedic residents do not affect short-term postoperative complications

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