Total Hip Arthroplasty in the Outpatient Setting

Sayeed, Zain; Abaab, Leila; El-Othmani, Mouhanad M.; Pallekonda, Vinay; Mihalko, William M.; Saleh, Khaled J.

doi:10.1016/j.ocl.2017.08.004

Cited by 8 publications

(4 citation statements)

References 79 publications

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“…Age and body mass index were not exclusion criteria: planned surgical procedures did not require general anesthesia, thus eliminating concerns of postoperative hypoxia due to apnea or airway difficulty due to paralysis of the respiratory tract. 13,14 Substantial cost reduction in the high-efficiency OR was achieved by (a) using patient selection criteria recommended for ambulatory surgery (i.e., American Society of Anesthesiologists [ASA] score ≤ 3), 13,[15][16][17][18] permitting the use of local anesthesia and nerve blocks (proven to provide better pain control 19 ), eliminating the need for PACU; (b) eliminating the scrub nurse, as well as designating roles to the circulating nurse or OR aide, thus saving 1 full-time salaried position; [20][21][22] (c) minimizing the number of instruments and amount of equipment required to perform surgeries (the highefficiency OR carried out less complex cases and thus required fewer tools); and (d) grouping similar cases together, allowing for better operative efficiency. 23 A minimal, negligible increase in physiotherapy cost was offset by improved outcomes for the patients and led to a relative decrease in the surgeon workload.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Chohan

Bihari

Tieszer

et al. 2022

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Background: Wait times for many elective orthopedic surgical procedures in Ontario have become unacceptably long and substantially exceed the recommended guidelines. As a consequence, many patients experience chronic pain, disability and other poor health outcomes. The purpose of this study was to test a novel, resource-saving redesign of outpatient operating room (OR) services, based on tiered grouping of surgical cases, to maximize health benefits for patients while improving efficiency and decreasing wait times.Methods: This prospective cohort study enrolled adult patients scheduled to undergo unilateral lower limb procedures that had a low requirement for surgical resources and did not require admission to the hospital (ambulatory surgical services) at an academic hospital. Patients were randomly assigned to a conventional OR group or a high-efficiency (tiered) OR group, in which the intensity of surgical, anesthesia and nursing resources was matched to the procedure and the patient's health status. The tiered OR made use of local anesthesia and a block room rather than general anesthesia. Primary outcomes were costs of surgical services provided and patient health outcomes; secondary outcomes were patient and staff satisfaction with each OR setup. Results:The costs associated with the high-efficiency OR were 60% lower than those associated with the conventional OR (this was primarily due to the streamlining of OR care and elimination of the need to use a postanesthetic care unit), with the same or equivalent patient health outcomes. No differences in patient and staff satisfaction were found between the 2 setups. Conclusion:The use of tiered, ambulatory services for elective orthopedic surgery does not compromise health outcomes and patient satisfaction, and it is associated with substantial cost savings.Contexte : En Ontario, les temps d'attentes de plusieurs interventions en chirurgie orthopédique non urgentes s'allongent déraisonnablement et excèdent largement ceux des lignes directrices. Par conséquent, plusieurs patients doivent vivre avec de la douleur chronique, une invalidité ou d'autres problèmes de santé. Le but de cette étude était de mettre à l'essai une nouvelle configuration des services en salle d'opération pour les patients ambulatoires qui permettrait d'économiser les ressources et qui se fonderait sur un regroupement des cas chirurgicaux en échelons afin de maximiser les bienfaits pour la santé des patients tout en améliorant l'efficacité et en diminuant les temps d'attente.Méthodes : Dans cette étude de cohorte prospective, les patients adultes participants ont subi dans un hôpital universitaire une intervention chirurgicale unilatérale à un membre inférieur demandant peu de ressources et ne nécessitant pas d'hospitalisation (services de chirurgie ambulatoire). Les patients étaient répartis aléatoirement en 2 groupes : 1 groupe était assigné à une salle d'opération classique, et l'autre à une salle à rendement élevé (interventions échelonnées), où l'intensité des ressources allouées à l'in...

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Section: Discussionmentioning

confidence: 99%

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Chohan

Bihari

Tieszer

et al. 2022

cjs

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“…The ASA score is accepted in the medical community as an index of the risk associated with surgery. However, Sayeed et al 42 suggested that because the original purpose of the ASA score was not to safely select outpatient THA candidates, and because it has not been validated for use in rapid recovery THA programs, it should not be considered as a predictive factor for early discharge. This further underlines the need for studies focusing on patient profiling to select the most suitable candidates for a safe and successful outpatient THA.…”

Section: Discussionmentioning

confidence: 99%

Outpatient total hip arthroplasty does not increase complications and readmissions: a meta-analysis

et al. 2020

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Background: There is no consensus about the safety of outpatient total hip arthroplasty (THA). Therefore, the purpose of this meta-analysis was to quantitatively evaluate and compare outpatient and inpatient THA studies in terms of complication and readmission rates. Methods: A systematic search of the literature was performed on 26 July 2019 on PubMed, Web of Science, Cochrane library, and on the grey literature databases. The papers thus collected were used for a meta-analysis comparing outpatient and inpatient THA in terms of complication and readmission rates. Risk of bias and quality of evidence were defined according to Cochrane guidelines. The PRISMA guidelines were used to determine which papers to include in this study. Results: The literature search resulted in 2317 articles; of these, 8 articles were used for the meta-analysis. A total of 66,971 patients were included, of which 1428 were THA outpatients. The overall complication rate for outpatient THAs was 3.0%, while inpatient THAs had an overall complication rate of 4.7%. The readmission rate was 1.4% in outpatient THAs and 3.0% in inpatient THAs. Only 6 studies reported the number of deaths, which ranged from 0% to 0.01%. The included studies present a moderate risk of bias and, according to GRADE guidelines, the level of evidence for complications and readmissions is very low. Conclusions: This meta-analysis documented that outpatient THA is a feasible approach since it does not increase complications or readmissions with respect to inpatient THA, but the available studies present a moderate risk of bias and the quality of evidence of these findings is very low. Future high-level studies are needed to confirm results and indications for outpatient THA.

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“…3 En Estados Unidos, se proyecta que en 2030 la frecuencia de realización de artroplastia de cadera será de 1 385 649. 3,4 Además, Register et al 5 reportaron que en 2014 se realizaron más de 1 millón de artroplastias electivas de extremidades inferiores en dicho país, con reembolsos por procedimiento entre USD 16 500 y USD 75 000. 5 En este sentido, se evidencia la importancia de trabajar en la realización de protocolos y estrategias para disminuir el impacto económico de este tipo de procedimientos, incluyendo aquellos con un manejo ambulatorio del paciente.…”

Section: Introductionunclassified

“…El desarrollo de procedimientos quirúrgicos menos invasivos y de estrategias para prevenir la pérdida de sangre, así como un mejor control del dolor perioperatorio en pacientes ambulatorios en comparación con aquellos que reciben manejo intrahospitalario [6][7][8] han permitido mejorar los protocolos de rehabilitación, disminuyendo la frecuencia de posibles complicaciones inherentes a la hospitalización [9][10][11][12][13] y los costos para los sistemas de salud. 4,14 En este contexto, surge la necesidad de estudiar la satisfacción y el control del dolor en pacientes sometidos a RTC con manejo ambulatorio.…”

Section: Introductionunclassified

Niveles de dolor y satisfacción en pacientes sometidos a reemplazo total de cadera bilateral en dos tiempos quirúrgicos (manejo ambulatorio e intrahospitalario)

Ramírez-Guerrero,

Manrique-González,

Restrepo-Uribe

et al. 2023

Rev. colomb. ortop traumatol.

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Introducción. Con la mejora en las técnicas quirúrgicas de implantación de prótesis de cadera, los avances en analgesia y la estandarización de protocolos posoperatorios, junto con la rehabilitación temprana, se ha disminuido la estancia hospitalaria y se ha favorecido la realización de reemplazos totales de cadera (RTC) ambulatorios. Objetivo. Determinar los niveles de dolor y satisfacción posoperatorios en pacientes sometidos a cirugía de RTC bilateral en dos tiempos quirúrgicos (tiempo 1: manejo ambulatorio; tiempo 2: manejo intrahospitalario) y comparar de manera exploratoria dichos niveles entre los tiempos quirúrgicos. Metodología. Estudio observacional descriptivo realizado en 52 pacientes sometidos a RTC bilateral en dos tiempos quirúrgicos en dos hospitales de cuarto nivel de atención de Bogotá D.C. (Colombia) entre enero de 2013 y noviembre de 2022. El dolor posoperatorio fue evaluado con la escala visual análoga (EVA) y la satisfacción con el procedimiento, mediante la escala validada de satisfacción del paciente autodiligenciada (SAPS). Resultados. La mediana de edad fue 64,5 años y 65,38% fueron mujeres. El puntaje promedio en la EVA fue 5,35 y 5,73 en el primer y segundo tiempo, respectivamente (p=0,52). Además, la mediana del puntaje global en la SAPS en ambos tiempos fue 93,7 (p=0,91). Se observó una mayor frecuencia de reconsulta a urgencias (1,92% vs. 9,62%; p=0,02) y eventos adversos (0 vs. 1,92%; p=0,84) en el segundo tiempo quirúrgico. Conclusiones. La satisfacción con el procedimiento fue alta en ambos tiempos quirúrgicos y el nivel de dolor fue mayor en el segundo tiempo, sin que la diferencia fuera estadísticamente significativa.

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Total Hip Arthroplasty in the Outpatient Setting

Cited by 8 publications

References 79 publications

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Evaluation of a tiered operating room strategy at an academic centre: comparing high-efficiency and conventional operating rooms

Outpatient total hip arthroplasty does not increase complications and readmissions: a meta-analysis

Niveles de dolor y satisfacción en pacientes sometidos a reemplazo total de cadera bilateral en dos tiempos quirúrgicos (manejo ambulatorio e intrahospitalario)

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