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https://www.readbyqxmd.com/read/29771724/early-impact-of-medicare-accountable-care-organizations-on-inpatient-surgical-spending
#1
Hari Nathan, Jyothi R Thumma, Andrew M Ryan, Justin B Dimick
OBJECTIVE: To evaluate whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. BACKGROUND: ACOs have proliferated rapidly and now cover more than 32 million Americans. Medicare Shared Savings Program (MSSP) ACOs have shown modest success in reducing medical spending. Whether they have reduced surgical spending remains unknown. METHODS: We used 100% Medicare claims from 2010 to 2014 for patients aged 65 to 99 years undergoing 6 common elective surgical procedures [abdominal aortic aneurysm (AAA) repair, colectomy, coronary artery bypass grafting (CABG), hip or knee replacement, or lung resection]...
May 16, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29739239/total-hip-replacement-provokes-endothelial-dysfunction
#2
Peter Poredos, Ana Mavric, Lara Leben, Pavel Poredos, Mateja Kaja Jezovnik
Surgery represents an increased risk of different perioperative complications. Endothelial function (EF) is a key mechanism responsible for cardiovascular homeostasis and is involved in thromboembolic complications. We aimed to follow changes of EF in an early postoperative period in patients undergoing total hip replacement (THR). Endothelial function was assessed noninvasively in 70 consecutive patients who underwent an elective THR under spinal anesthesia. Flow-mediated dilation (FMD) and low flow-mediated constriction capability of the brachial artery, which are indicators of EF were measured before the operation (baseline), 24 hours after the operative procedure, and 5 to 7 days postoperatively...
January 1, 2018: Angiology
https://www.readbyqxmd.com/read/29691166/improved-perioperative-care-of-elective-joint-replacement-patients-the-impact-of-an-orthopedic-perioperative-hospitalist
#3
Steven J Fitzgerald, Terrence C Palmer, Matthew J Kraay
BACKGROUND: We developed an orthopedic hospitalist fellowship program for our total joint replacement program at a large urban academic medical center. The goal of the program was to improve patient outcomes, quality, and healthcare value through collaborative perioperative care and improved care coordination. This study evaluates the implementation and impact of our modified Hospitalist-Orthopaedic Team Co-management model on quality and performance metrics. METHODS: We reviewed our Quality Institute data using 3 databases for the 16 months before (PreOH) and 18 months after (PostOH) implementation...
March 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29691152/readmission-patterns-over-90-day-episodes-of-care-among-medicare-fee-for-service-beneficiaries-discharged-to-post-acute-care
#4
Addie Middleton, Yong-Fang Kuo, James E Graham, Amol Karmarkar, Yu-Li Lin, James S Goodwin, Allen Haas, Kenneth J Ottenbacher
OBJECTIVE: Examine readmission patterns over 90-day episodes of care in persons discharged from hospitals to post-acute settings. DESIGN: Retrospective cohort study. SETTING: Acute care hospitals. PARTICIPANTS: Medicare fee-for-service enrollees (N = 686,877) discharged from hospitals to post-acute care in 2013-2014. The cohort included beneficiaries >65 years of age hospitalized for stroke, joint replacement, or hip fracture and who survived for 90 days following discharge...
April 21, 2018: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29657460/a-quality-improvement-project-decreases-incidence-of-pulmonary-embolism-following-arthroplasty
#5
Iyad Eid, Dane Moran, Lynn Morrison, Eyad HajHussein, Hanna Hill, Rasha Ansari, Tammy Williams, Mojieb Manzary
Objective: To develop a quality improvement initiative to reduce the incidence of pulmonary embolism (PE) following elective lower extremity joint replacement surgery. Methods: 866 Patients undergoing a total knee or total or partial hip replacement surgery at a from 2014 to 2016 were included in this prospective pre-post interventional study. Results: There were 13 PE's before the intervention and 2 after the intervention. The incidence of PE was significantly higher prior to the intervention (2...
March 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29648889/patient-reported-allergies-do-not-predict-poorer-promis-function-pain-and-depression-scores-following-foot-and-ankle-surgery
#6
Devon C Nixon, Brian M Cusworth, Jeremy J McCormick, Jeffrey E Johnson, Sandra E Klein
BACKGROUND: Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery...
April 1, 2018: Foot & Ankle International
https://www.readbyqxmd.com/read/29643693/joint-perception-and-patient-perceived-satisfaction-after-total-hip-and-knee-arthroplasty-in-the-american-population
#7
Matthew Varacallo, Rajit Chakravarty, Kevin Denehy, Andrew Star
Background: Total hip (THA) and knee arthroplasty (TKA) are two of the most successful procedures in orthopedics. Current evaluation trends focus on patient-reported outcomes. We sought to compare the changing WOMAC scores from various time points from pre-operative to 1-year follow-up between separate THA and TKA cohorts. In addition, we compared THA and TKA patients' joint perception, satisfaction, and function via a questionnaire. Methods: One hundred elective THA (n = 50) and TKA (n = 50) patients at one institution were randomly selected and contacted between 2 and 4 years after the index surgery...
June 2018: Journal of Orthopaedics
https://www.readbyqxmd.com/read/29622493/hip-fracture-does-not-belong-in-the-elective-arthroplasty-bundle-presentation-outcomes-and-service-utilization-differ-in-fracture-arthroplasty-care
#8
William C Schroer, Paul J Diesfeld, Angela R LeMarr, Diane J Morton, Mary E Reedy
BACKGROUND: Center for Medicare and Medicaid Services reimbursement is the same for hip arthroplasty performed electively for arthritis and urgently for femoral neck fracture. METHODS: An analytic report of hip arthroplasty for a 5-hospital network identified 2362 cases performed from January 2014 to May 2016. Resource utilization was determined using 90-day charges. RESULTS: The fracture population (623 hips) was older (P < .01), had more medical comorbidities (28...
March 14, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29601379/moderate-to-severe-renal-insufficiency-is-associated-with-high-mortality-after-hip-and-knee-replacement
#9
Pyry Jämsä, Esa Jämsen, Heini Huhtala, Antti Eskelinen, Niku Oksala
BACKGROUND: In patients having elective hip or knee replacements, many comorbid conditions, including diabetes, cardiovascular disease, and congestive heart failure, are associated with postoperative mortality. Renal failure and a history of renal transplantation also increase mortality. However, the effect of different stages of chronic kidney disease on patients' prognoses is unclear. QUESTIONS/PURPOSES: (1) What is the risk of postoperative mortality in different stages of chronic kidney disease after elective hip or knee replacement and does the risk increase with mild renal insufficiency? (2) How severe is the risk of death in patients with chronic kidney disease compared with other major medical comorbidities such as diabetes, cardiovascular disease, and congestive heart failure? (3) Are there risk factor combinations associated with especially poor survival? METHODS: Using longitudinally maintained databases, the records of 18,575 patients (median age 69 years, 63% female, median body mass index 29 kg/m) undergoing elective hip and knee replacements from a single center between 2002 and 2011 were analyzed in this retrospective study...
March 28, 2018: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/29573515/knowledge-expectations-of-orthopaedic-patients
#10
Sara Cano-Plans, Laia Lacueva-Pérez, Esther Cabrera, Adelaida Zabalegui
AIM: To describe and compare knowledge expectations and received knowledge in elective orthopaedic surgery patients. BACKGROUND: Population aging, increasing incidence of osteoarthritis, the growing number of surgical procedures, and reduced clinical stays underline the need for a new approach to patient education. DESIGN: This study has a descriptive, comparative design. METHODS: Data were collected from 263 patients who had total hip and knee replacement elective surgery during 3 years (2009-2012) in 5 public hospitals in Spain...
March 24, 2018: International Journal of Nursing Practice
https://www.readbyqxmd.com/read/29557090/-rivaroxaban-for-thrombosis-prophylaxis-in-extensive-hip-and-knee-operations-subanalysis-of-the-german-cohort-xamos-de-of-non-interventional-study-xamos
#11
Patrick Mouret, Reinhold Kreutz, Katrin Deilmann, Ariane Dihlmann, Gerlind Holberg, Sylvia Haas
BACKGROUND: In global admission studies (RECORD I-IV) Rivaroxaban and enoxaparin as a standard prophylaxis were comparable in safety of treatment, but rivaroxaban appeared more effective in prevention of venous thromboembolism (VTE) when used in elective hip and knee replacement. The worldwide non-interventional cohort study XAMOS confirmed these results in the clinical routine compared to proven anticoagulants. METHOD: Efficacy and safety of rivaroxaban was to be compared with the standard prophylaxis in the prevention of VTE after elective hip and knee replacement surgery in clinical practice in Germany...
October 2017: MMW Fortschritte der Medizin
https://www.readbyqxmd.com/read/29540418/cost-effectiveness-of-enhanced-recovery-in-hip-and-knee-replacement-a-systematic-review-protocol
#12
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
https://www.readbyqxmd.com/read/29530912/national-trends-in-emergency-readmission-rates-a-longitudinal-analysis-of-administrative-data-for-england-between-2006-and-2016
#13
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
https://www.readbyqxmd.com/read/29523446/reasons-for-ninety-day-emergency-visits-and-readmissions-after-elective-total-joint-arthroplasty-results-from-a-us-integrated-healthcare-system
#14
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
https://www.readbyqxmd.com/read/29489471/do-patients-live-longer-after-tha-and-is-the-relative-survival-diagnosis-specific
#15
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
https://www.readbyqxmd.com/read/29468091/surgical-technical-evidence-review-for-elective-total-joint-replacement-conducted-for-the-ahrq-safety-program-for-improving-surgical-care-and-recovery
#16
REVIEW
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
https://www.readbyqxmd.com/read/29462036/the-cost-of-joint-replacement-comparing-two-approaches-to-evaluating-costs-of-total-hip-and-knee-arthroplasty
#17
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
https://www.readbyqxmd.com/read/29419468/disparities-in-outcomes-for-blacks-versus-whites-undergoing-total-hip-arthroplasty-a-systematic-literature-review
#18
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
https://www.readbyqxmd.com/read/29416151/pre-procedure-ultrasound-guided-paramedian-spinal-anaesthesia-at-l5-s1-is-this-better-than-landmark-guided-midline-approach-a-randomised-controlled-trial
#19
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
https://www.readbyqxmd.com/read/29338705/frailty-as-a-predictor-of-hospital-length-of-stay-after-elective-total-joint-replacements-in-elderly-patients
#20
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
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