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Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission.
J Arthroplasty 2019; 34(7S):S91-S96JA

Abstract

BACKGROUND

It is well recognized that unplanned readmissions following total joint arthroplasty (TJA) are more prevalent in patients with comorbidities. However, few investigators have delayed surgery and medically optimized patients prior to surgery. In its current form, the Perioperative Orthopedic Surgical Home (POSH) is a surgeon-led screening and optimization initiative targeting 8 common modifiable comorbidities.

METHODS

A total of 4188 patients who underwent TJA between January 2014 and December 2016 were retrospectively screened by the Readmission Risk Assessment tool (RRAT) score. one thousand one hundred and ninety four subjects had a preoperative RRAT score ≥3 and were eligible for inclusion. Patients were then separated into 2 cohorts based on whether they were enrolled into the POSH initiative (POSH; n = 216) or continued with surgery (non-POSH; n = 978) despite their risk.

RESULTS

Since the implementation of the POSH initiative, patients with RRAT scores ranging from 3 to 5 have experienced lower 30-day (1.6% vs 5.3%, P = .03) and 90-day (3.2% vs 7.4%, P < .05) readmission rates when compared to the non-POSH cohort. Only 15.3% of medically optimized patients enrolled in the POSH initiative were discharged to a post-acute care facility, whereas 23.4% of non-POSH patients were discharged to a post-acute care facility (P = .01). There were no differences in length of stay and infection rates between the 2 cohorts. Moreover, 90-day episode-of-care costs were 14.9% greater among non-POSH Medicare TJA recipients and 32.6% higher if a readmission occurred.

CONCLUSION

The identification and medical optimization of comorbidities prior to surgical intervention may enhance the value of care TJA candidates receive. A standardized multidisciplinary approach to the medical optimization of high-risk TJA candidates may improve patient engagement and perioperative outcomes, while reducing cost associated with TJA.

LEVEL OF EVIDENCE

Level III, Retrospective Cohort Study.

Authors+Show Affiliations

Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30745217

Citation

Kim, Kelvin Y., et al. "Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission." The Journal of Arthroplasty, vol. 34, no. 7S, 2019, pp. S91-S96.
Kim KY, Anoushiravani AA, Chen KK, et al. Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission. J Arthroplasty. 2019;34(7S):S91-S96.
Kim, K. Y., Anoushiravani, A. A., Chen, K. K., Li, R., Bosco, J. A., Slover, J. D., & Iorio, R. (2019). Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission. The Journal of Arthroplasty, 34(7S), pp. S91-S96. doi:10.1016/j.arth.2019.01.020.
Kim KY, et al. Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission. J Arthroplasty. 2019;34(7S):S91-S96. PubMed PMID: 30745217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative Orthopedic Surgical Home: Optimizing Total Joint Arthroplasty Candidates and Preventing Readmission. AU - Kim,Kelvin Y, AU - Anoushiravani,Afshin A, AU - Chen,Kevin K, AU - Li,Robert, AU - Bosco,Joseph A, AU - Slover,James D, AU - Iorio,Richard, Y1 - 2019/01/18/ PY - 2018/08/30/received PY - 2019/01/08/revised PY - 2019/01/10/accepted PY - 2019/2/13/pubmed PY - 2019/2/13/medline PY - 2019/2/13/entrez KW - Readmission risk assessment tool KW - perioperative optimizations KW - perioperative orthopedic surgical home KW - practice management KW - total joint arthroplasty SP - S91 EP - S96 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 34 IS - 7S N2 - BACKGROUND: It is well recognized that unplanned readmissions following total joint arthroplasty (TJA) are more prevalent in patients with comorbidities. However, few investigators have delayed surgery and medically optimized patients prior to surgery. In its current form, the Perioperative Orthopedic Surgical Home (POSH) is a surgeon-led screening and optimization initiative targeting 8 common modifiable comorbidities. METHODS: A total of 4188 patients who underwent TJA between January 2014 and December 2016 were retrospectively screened by the Readmission Risk Assessment tool (RRAT) score. one thousand one hundred and ninety four subjects had a preoperative RRAT score ≥3 and were eligible for inclusion. Patients were then separated into 2 cohorts based on whether they were enrolled into the POSH initiative (POSH; n = 216) or continued with surgery (non-POSH; n = 978) despite their risk. RESULTS: Since the implementation of the POSH initiative, patients with RRAT scores ranging from 3 to 5 have experienced lower 30-day (1.6% vs 5.3%, P = .03) and 90-day (3.2% vs 7.4%, P < .05) readmission rates when compared to the non-POSH cohort. Only 15.3% of medically optimized patients enrolled in the POSH initiative were discharged to a post-acute care facility, whereas 23.4% of non-POSH patients were discharged to a post-acute care facility (P = .01). There were no differences in length of stay and infection rates between the 2 cohorts. Moreover, 90-day episode-of-care costs were 14.9% greater among non-POSH Medicare TJA recipients and 32.6% higher if a readmission occurred. CONCLUSION: The identification and medical optimization of comorbidities prior to surgical intervention may enhance the value of care TJA candidates receive. A standardized multidisciplinary approach to the medical optimization of high-risk TJA candidates may improve patient engagement and perioperative outcomes, while reducing cost associated with TJA. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/30745217/Perioperative_Orthopedic_Surgical_Home:_Optimizing_Total_Joint_Arthroplasty_Candidates_and_Preventing_Readmission_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(19)30047-6 DB - PRIME DP - Unbound Medicine ER -