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elective Knee replacement

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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/29753618/predictors-and-cost-of-readmission-in-total-knee-arthroplasty
#2
Kenneth L Urish, Yongmei Qin, Benjamin Y Li, Tudor Borza, Michael Sessine, Peter Kirk, Brent K Hollenbeck, Jonathan E Helm, Mariel S Lavieri, Ted A Skolarus, Bruce L Jacobs
BACKGROUND: The Comprehensive Care for Joint Replacement bundle was created to decrease total knee arthroplasty (TKA) cost. To help accomplish this, there is a focus on reducing TKA readmissions. However, there is a lack of national representative sample of all-payer hospital admissions to direct strategy, identify risk factors for readmission, and understand actual readmission cost. METHODS: We used the Nationwide Readmission Database to examine national readmission rates, predictors of readmission, and associated readmission costs for elective TKA procedures...
April 17, 2018: Journal of Arthroplasty
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/29658483/bacteriology-and-risk-factors-associated-with-periprosthetic-joint-infection-after-primary-total-knee-arthroplasty-retrospective-study-of-2543-cases
#5
K T Siu, F Y Ng, P K Chan, H Ch Fu, C H Yan, K Y Chiu
INTRODUCTION: Periprosthetic joint infection after total knee arthroplasty is a serious complication. This study aimed to identify risk factors and bacteriological features associated with periprosthetic joint infection after primary total knee arthroplasty performed at a teaching hospital. METHODS: We reviewed 2543 elective primary total knee arthroplasties performed at our institution from 1993 to 2013. Data were collected from the Hong Kong Hospital Authority's Clinical Data Analysis and Reporting System, the Infection Control Team, and the joint replacement division registry...
April 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/29657460/a-quality-improvement-project-decreases-incidence-of-pulmonary-embolism-following-arthroplasty
#6
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
#7
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
#8
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/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/29596539/the-sociocultural-effects-on-orthopedic-surgeries-in-taiwan
#10
Shin-Lin Chiu, Mei-Jih Gee, Chih-Hsin Muo, Chiao-Lee Chu, Shou-Jen Lan, Chiu-Liang Chen
Various sociocultural factors affect healthcare-seeking behaviors. In Taiwanese society, superstitions and lunar festivals play important roles in people's lives. We investigated the impact of "Ghost Month" (the 7th lunar month) and Chinese New Year (the 12th lunar month and the 1st lunar month of the following year) on the number of elective surgeries and emergent surgeries in Taiwan. The number of total knee replacement (TKR) surgeries and proximal femur fracture (PFF) surgeries in each lunar month from 2000 to 2011 were extracted from the Taiwan National Health Insurance Database, a computerized and population-based database...
2018: PloS One
https://www.readbyqxmd.com/read/29573515/knowledge-expectations-of-orthopaedic-patients
#11
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
#12
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/29541841/much-ado-about-nothing-the-effect-of-tourniquet-time-on-an-accelerated-rehabilitation-programme-following-total-knee-replacement-tkr
#13
William Wynell-Mayow, Muhammad Zahid Saeed
BACKGROUND: The WHO includes osteoarthritis as a disease of priority, owing to its significant impact on quality of life, and globally increasing prevalence. Hospital budgets are under pressure to ration knee replacements and shorten inpatient stays. Prolonged tourniquet application has been hypothesised to extend recovery through pain and reduced mobility. PATIENTS AND METHODS: A total of 123 elective total knee replacements meeting inclusion criteria took place from July 2015 to October 2017 at the Royal Free Hospital...
March 14, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
https://www.readbyqxmd.com/read/29540418/cost-effectiveness-of-enhanced-recovery-in-hip-and-knee-replacement-a-systematic-review-protocol
#14
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
#15
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
#16
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/29484267/pocd-in-patients-receiving-total-knee-replacement-under-deep-vs-light-anesthesia-a-randomized-controlled-trial
#17
Ruixue Hou, Hong Wang, Lianhua Chen, Yimin Qiu, Shitong Li
Objectives: Clinical observation, as well as randomized controlled trials, indicated an increasing rate of postoperative cognitive dysfunction (POCD) with increasing depth of general anesthesia. However, the findings are subject to bias due to varying degree of analgesia. In this trial, we compared the rate of POCD between patients receiving light versus high anesthesia while holding analgesia comparable using nerve block. Methods: Elderly patients (≧60 years) receiving elective total knee replacement were randomized to receive the surgery under general anesthesia at BIS 40-50 (LOBIS group) or BIS 55-65 (HIBIS group)...
February 2018: Brain and Behavior
https://www.readbyqxmd.com/read/29480088/resource-utilization-and-charges-of-patients-with-and-without-diagnosed-venous-thromboembolism-during-primary-hospitalization-and-after-elective-inpatient-surgery-a-retrospective-study
#18
Aryana Sepassi, Francine Chingcuanco, Ronald Gordon, Angela Meier, Victoria Divino, Mitch DeKoven, Rami Ben-Joseph
AIMS: To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US. METHODS: The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE...
March 1, 2018: Journal of Medical Economics
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
#19
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
#20
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
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