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elective Hip replacement

Jacqueline Murphy, Mark G Pritchard, Lok Yin Cheng, Roshni Janarthanan, José Leal
INTRODUCTION: Hip and knee replacement represents a significant burden to the UK healthcare system. 'Enhanced recovery' pathways have been introduced in the National Health Service (NHS) for patients undergoing hip and knee replacement, with the aim of improving outcomes and timely recovery after surgery. To support policymaking, there is a need to evaluate the cost-effectiveness of enhanced recovery pathways across jurisdictions. Our aim is to systematically summarise the published cost-effectiveness evidence on enhanced recovery in hip and knee replacement, both as a whole and for each of the various components of enhanced recovery pathways...
March 14, 2018: BMJ Open
Rocco Friebel, Katharina Hauck, Paul Aylin, Adam Steventon
OBJECTIVE: To assess trends in 30-day emergency readmission rates across England over one decade. DESIGN: Retrospective study design. SETTING: 150 non-specialist hospital trusts in England. PARTICIPANTS: 23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016. PRIMARY AND SECONDARY OUTCOMES: We examined emergency admissions that occurred within 30 days of discharge from hospital ('emergency readmissions') as a measure of healthcare quality...
March 12, 2018: BMJ Open
Matthew P Kelly, Heather A Prentice, Wei Wang, Brian H Fasig, Dhiren S Sheth, Elizabeth W Paxton
BACKGROUND: Previous studies evaluating reasons for 30-day readmissions following total joint arthroplasty (TJA) may underestimate hospital-based utilization of healthcare resources during a patient's episode-of-care. We sought to identify common reasons for 90-day emergency department (ED) visits and hospital readmissions following primary elective unilateral TJA. METHODS: Patients from July 1, 2012 through June 30, 2015 having primary elective TJA and at least one 90-day postoperative ED-only visit and/or readmission for any reason were identified using the Kaiser Permanente Total Joint Replacement Registry...
February 12, 2018: Journal of Arthroplasty
Peter Cnudde, Ola Rolfson, A John Timperley, Anne Garland, Johan Kärrholm, Göran Garellick, Szilard Nemes
BACKGROUND: Hip replacements are successful in restoring mobility, reducing pain, and improving quality of life. However, the association between THA and the potential for increased life expectancy (as expressed by mortality rate) is less clear, and any such association could well be influenced by diagnosis and patient-related, socioeconomic, and surgical factors, which have not been well studied. QUESTIONS/PURPOSES: (1) After controlling for birth year and sex, are Swedish patients who underwent THA likely to survive longer than individuals in the general population? (2) After controlling for relevant patient-related, socioeconomic/demographic factors and surgical factors, does relative survival differ across the various diagnoses for which THAs were performed in Sweden? METHODS: Data from the Swedish Hip Arthroplasty Register, linked to administrative health databases, were used for this study...
February 28, 2018: Clinical Orthopaedics and related Research
Christopher P Childers, Anaar E Siletz, Emily S Singer, Claire Faltermeier, Q Lina Hu, Clifford Y Ko, Gregory J Golladay, Stephen L Kates, Elizabeth C Wick, Melinda Maggard-Gibbons
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
John A Palsis, Thomas S Brehmer, Vincent D Pellegrini, Jacob M Drew, Barton L Sachs
BACKGROUND: In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. METHODS: We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods...
February 21, 2018: Journal of Bone and Joint Surgery. American Volume
Bella Y Mehta, Anne R Bass, Rie Goto, Linda A Russell, Michael L Parks, Mark P Figgie, Susan M Goodman
OBJECTIVE: Total hip replacement (THA) surgery is a successful procedure, yet blacks in the United States undergo THA less often and reflect poorer outcomes than whites. The purpose of this study is to systematically review the literature on health-related quality of life after THA, comparing blacks and whites. METHODS: A librarian-assisted search was performed in Medline through PubMed, Embase, and Cochrane Library on February 27, 2017. Original cohort studies examining pain, function, and satisfaction in blacks and whites 1 year after elective THA were included...
February 1, 2018: Journal of Rheumatology
Karthikeyan Kallidaikurichi Srinivasan, Anne-Marie Leo, Gabriella Iohom, Frank Loughnane, Peter J Lee
Background and Aims: Routine use of pre-procedural ultrasound guided midline approach has not shown to improve success rate in administering subarachnoid block. The study hypothesis was that the routine use of pre-procedural (not real time) ultrasound-guided paramedian spinals at L5-S1 interspace could reduce the number of passes (i.e., withdrawal and redirection of spinal needle without exiting the skin) required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach...
January 2018: Indian Journal of Anaesthesia
Han Ting Wang, Josée Fafard, Stéphane Ahern, Pascal-André Vendittoli, Paul Hebert
BACKGROUND: Total joint replacement procedures are increasing in number because of population aging and osteoarthritis development. Defined as a lack of physiological reserves and the inability to adequately respond to external stressors, frailty may be more common than expected in older patients with degenerative arthritis awaiting total joint replacements. The aim of the present study was to assess associations between frailty and adverse outcomes, frailty prevalence among elderly patients awaiting elective TJR, and agreement between 2 frailty screening instruments...
January 16, 2018: BMC Musculoskeletal Disorders
Maria Qvistgaard, Sofia Almerud Österberg, Kristiina Heikkilä, Ann-Britt Thorén, Jenny Lovebo
The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery...
July 2017: Journal of Perioperative Practice
Ernest R Vina, Michael J Kallan, Aliya Collier, Charles L Nelson, Said A Ibrahim
Background: Three-quarters of patients who undergo total hip replacement (THR) receive postsurgical rehabilitation care in an inpatient rehabilitation facility (IRF), a skilled nursing facility (SNF), or through a home health agency. The objectives of this study are to examine racial differences where THR recipients receive postsurgical rehabilitation care and determine whether discharge destination is associated with hospital readmission. Methods: Using the Pennsylvania Health Care Cost Containment Council database, we selected African American (AA) or white adults who underwent THR surgery (n = 68,016)...
December 2017: Geriatric Orthopaedic Surgery & Rehabilitation
Dirk Pieter Hogerzeil, Imraan Muradin, Eline W Zwitser, Joris A Jansen
Acute compartment syndrome (ACS) of the thigh following primary total hip arthroplasty (THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed...
December 18, 2017: World Journal of Orthopedics
Martina Heschl, Hans Gombotz, Bettina Haslinger-Eisterer, Axel Hofmann, Nikolaus Böhler, Jens Meier
BACKGROUND: Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date...
April 2018: European Journal of Anaesthesiology
Jean Wong, David Lam, Stephen Choi, Mandeep Singh, Naveed Siddiqui, Sanjeev Sockalingam, Frances Chung
BACKGROUND: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium...
January 3, 2018: BMC Anesthesiology
Charles D Qin, Mia M Helfrich, David W Fitz, Mark A Oyer, Kevin D Hardt, David W Manning
BACKGROUND: The demand for conversion of prior hip surgery to total hip arthroplasty (conversion THA) is likely to increase as a function of increasing US hip fracture burden in addition to its application in managing other conditions. Thus, outcome analysis is warranted to better inform value-based reimbursement schemes in the era of bundled payments. METHODS: Via Current Procedural Terminology codes, the National Surgical Quality Improvement Project data files were queried for all patients who underwent primary THA and conversion of previous hip surgery to THA from 2005 to 2014...
November 29, 2017: Journal of Arthroplasty
Matthias Goldstein, Carsten Feldmann, Hinnerk Wulf, Thomas Wiesmann
BACKGROUND: The antifibrinolytic agent tranexamic acid (TXA) is widely used for the prevention and treatment of hyperfibrinolytic states, such as in severe polytrauma. It can also be used for the systemic prevention of hemorrhage in elective orthopedic procedures. In this review, we assess the efficacy and risks of the prophylactic administration of tranexamic acid before major endoprosthetic surgery of the hip and knee. METHODS: This review is based on pertinent articles retrieved by a selective literature search in the PubMed and Cochrane Library databases...
December 1, 2017: Deutsches Ärzteblatt International
M Franzini, A Nesti, D Panetta, V Fierabracci, S Marchetti, P D Parchi, L Caponi, A Paolicchi, V Musetti, P Salvadori, M Edmin, A Pucci, E Bonicoli, M Scaglione, N Piolanti
Gamma-glutamyltransferase (GGT) has been recently identified as a bone-resorbing factor. The aim of this study was to investigate the association between plasma GGT fractions levels and bone quality. Plasma GGT fractions were analysed by gel-filtration chromatography. Bone quality was established quantitatively by two micro-CT derived microarchitectural parameters: the BV/TV (mineralised bone volume/total volume), and the SMI (structure model index) that describes the rod-like (low resistant) or plate-like (high-resistant) shape of bone trabeculae...
October 2017: Journal of Biological Regulators and Homeostatic Agents
Rohit Singh, George Evans, Amit Patel, Richard Jones
PURPOSE: It is regular practice that patients undergoing orthopaedic procedures particularly those related to arthroplasty are given both verbal and written information prior to their surgery. The aim of this study was to complete a 15 year audit cycle by assessing the patient understanding of the consent process in elective orthopaedic surgery following the introduction of patient information booklets, DVDs, web links, and "joint school." METHODS: 150 patients (50 patients in each cycle of the study) undergoing primary total hip arthroplasty were counselled about the audit and prospectively enrolled...
December 2017: Bulletin of the Hospital for Joint Diseases
W Saasouh, S Leung, H O Yilmaz, O Koyuncu, J You, N M Zimmerman, K Ruetzler, A Turan
Background: The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery. Methods: With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015...
October 1, 2017: British Journal of Anaesthesia
Pavel Šponer, Tomáš Kučera, Michal Grinac, Aleš Bezrouk, Daniel Waciakowski
INTRODUCTION: The aim of the study was to compare the clinical outcomes following elective and traumatic total hip arthroplasty in Parkinson's disease patients. MATERIALS AND METHODS: Ten patients with osteoarthritis comprise the elective group (mean age at operation 74 years; mean follow-up 82 months). Thirteen patients with femoral fracture comprise the hip fracture group (mean age 76 years; mean follow-up 54 months). All patients were followed up at 6 and 36 months postoperatively and at the time of the latest follow-up...
2017: Parkinson's Disease
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