Surgeon-led comorbidity screening can improve total joint arthroplasty outcomes

Written by Rachel Popa | January 28, 2019 | Print  |

Identifying comorbidities through the Perioperative Orthopaedic Surgical Home initiative can improve the quality of care total joint candidates receive, according to research published in the Journal of Arthroplasty.

Between January 2014 and December 2016, 4,188 patients underwent total joint arthroplasty and were retrospectively reviewed by the Readmission Risk Assessment tool score. Researchers identified 1,194 who were eligible for inclusion in the study. Patients were separated into two cohorts. In the first cohort, 216 patients were enrolled in the Perioperative Orthopaedic Surgical Home initiative, and in the second cohort, 978 patients continued with surgery despite their risk.

The key details to know:

1. Patients with Readmission Risk Assessment tool scores ranging from three to five experienced lower 30-day and 90-day readmission rates compared to the group that didn't participate in the Perioperative Orthopaedic Surgical Home initiative.

2. Only 15.3 percent of medically optimized patients enrolled in the Perioperative Orthopaedic Surgical Home initiative were discharged to a post-acute care facility, and 23.4 percent of patients not enrolled in the initiative were discharged to a post-acute care facility.

3. Ninety-day episode-of-care costs were 14.9 percent higher among Medicare patients undergoing total joint arthroplasty who were not in the Perioperative Orthopaedic Surgical Home initiative group, and 32.6 percent higher if there was a readmission.

4. Researchers concluded, "The identification and medical optimization of comorbidities prior to surgical intervention may enhance the value of care total joint arthroplasty candidates receive. A standardized multidisciplinary approach to the medical optimization of high-risk total joint arthroplasty candidates may improve patient engagement and perioperative outcomes, while reducing [costs] associated with total joint arthroplasty."

More articles on orthopedics & TJR:
3 key factors driving joint surgery to the outpatient setting
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AI system can improve total joint replacement surgery outcomes, reduce costs: 4 study insights

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