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Same day discharge for joint patients

Alex Sher, Aakash Keswani, Dong-Han Yao, Michael Anderson, Karl Koenig, Calin S Moucha
BACKGROUND: Same-day (<24 h) discharge total joint arthroplasty (TJA) may be a safe and effective option for certain patients with end-stage osteoarthritis. Given the growing pressure to improve quality and lower TJA episode costs, surgeons must identify which TJA patients can be appropriately discharged home quickly and safely. This study identifies characteristics associated with same-day discharge post-TJA as well as assesses risk factors for complications in this select patient population...
December 22, 2016: Journal of Arthroplasty
P Maxwell Courtney, Anthony J Boniello, Richard A Berger
BACKGROUND: As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols. METHODS: We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014...
December 14, 2016: Journal of Arthroplasty
John W Barrington
Postoperative pain management is vital to promoting recovery and improving clinical outcomes. Although improved understanding of pain pathways has led to the development of varied approaches for controlling pain after surgery, some approaches are associated with potentially harmful side effects. Several lines of evidence have demonstrated that opioid analgesics can have unwanted adverse effects on patients having surgery. Similarly, risks associated with femoral nerve blocks have outweighed the benefits. Liposomal bupivacaine has shown efficacy in reducing the need for opioid analgesics and nerve blocks...
November 2016: American Journal of Orthopedics
Gregg R Klein, Jason M Posner, Harlan B Levine, Mark A Hartzband
BACKGROUND: There is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. METHODS: Five hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery...
October 20, 2016: Journal of Arthroplasty
Jean-Noël A Argenson, Henrik Husted, Adolph Lombardi, Robert E Booth, Emmanuel Thienpont
Outpatient surgical procedures for adult hip and knee reconstruction are gaining interest on a worldwide basis and have been progressively increasing over the last few years. Preoperative screening needs to concentrate on both the patient's comorbidities and home environment to provide a proper alignment of expectations of the surgeon, the patient, and the patient's family. Preoperative multidisciplinary patient information covering all aspects of the upcoming treatment course is a mandatory step, focusing on pain management and early mobilization...
July 6, 2016: Journal of Bone and Joint Surgery. American Volume
Ross C Puffer, Kevin Tou, Rose E Winkel, Mohamad Bydon, Bradford Currier, Brett A Freedman
BACKGROUND CONTEXT: Postsurgical pain control is important in spine surgery as it can lead to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, and improved patient satisfaction. Liposomal bupivacaine (LB) is an injectable formulation of bupivacaine, providing prolonged local anesthesia, up to 72 hours postinjection. Although, LB has been used with increasing frequency following other musculoskeletal procedures, specifically total joint replacements, its pre-emptive analgesic effect following lumbar microdiskectomy has hitherto not been reported...
June 24, 2016: Spine Journal: Official Journal of the North American Spine Society
Hem Desai, Ryan Wong, Ahmed Khurshid Pasha
CONTEXT: Daptomycin is the only antibiotic available with in vitro bactericidal activity against vancomycin-resistant enterococci (VRE). Its increased use has resulted in cases of decreased daptomycin efficacy. Recent in vitro studies have shown effective use of beta (β)-lactam and daptomycin antibiotics, as a combination therapy, in the treatment of VRE. We describe a case of effective treatment in a patient with VRE infection using dual ampicillin and daptomycin therapy that shows bench-to-bedside application of the abovementioned finding...
May 2016: North American Journal of Medical Sciences
Rachel Mosher Henke, Zeynal Karaca, Paige Jackson, William D Marder, Herbert S Wong
This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions...
May 4, 2016: Medical Care Research and Review: MCRR
Bertrand W Parcells, Dean Giacobbe, David Macknet, Amy Smith, Mark Schottenfeld, David A Harwood, Stephen Kayiaros
For decades, the average hospital stay following total joint arthroplasty (TJA) has been getting shorter. The historical standard was several weeks of hospitalization, yet improvements in perioperative care have reduced the average length of stay to a few days. Medicare recognizes a 3-day inpatient stay as the standard of care following hip or knee replacement. Yet continued advances in minimally invasive surgical techniques, short-acting general anesthetics, long-acting local anesthetics, and blood loss management have further improved the safety and recovery for TJA procedures...
July 1, 2016: Orthopedics
Jacob Daynes, Matthew F Roth, Mark Zekaj, Ian Hudson, Claire Pearson, Rahul Vaidya
The objective of this retrospective study was to assess what factors affected length of stay (LOS) in 183 adult patients with native septic arthritis. Diagnosis was based on a representative physical examination, fluid cell count/Gram stain, and organisms isolated from joint fluid culture. Data included demographics, comorbidities, laboratory results, treatment, and discharge times. Joint fluid cultures were positive in 55% (100 of 183) of the patients, and these patients were the subjects of this study. Blood cultures were taken for 65 patients and were positive in 54%; when positive, they were found to be the same as isolates from joint fluid analysis 91% of the time...
July 1, 2016: Orthopedics
John W Barrington
There is a growing interest in performing joint arthroplasty on an outpatient or short-stay basis. Several factors make the hospital environment itself less than ideal for providing optimal health care, and follow-up of hospitalized patients represents a substantial time burden for the orthopedic surgeon. Essential components of a successful outpatient arthroplasty program include: robust screening of patients to ensure selection of appropriate candidates; preoperative patient preparation, including setting appropriate expectations; modification of surgical approaches where appropriate; and proactive, multimodal pain management to enable patients to walk earlier after surgery, so that they can be discharged home the same day...
October 2015: American Journal of Orthopedics
Neal K Viradia, Byron Gaing, Stella K Kang, Andrew B Rosenkrantz
OBJECTIVE: The purpose of this study was to retrospectively investigate associations between baseline CT findings in suspected acute appendicitis and subsequent hospital resource utilization. MATERIALS AND METHODS: One hundred thirty-eight patients (76 male and 62 female patients; mean [± SD] age, 40 ± 21 years) who were admitted for suspected acute appendicitis and underwent baseline CT were included. A single radiologist reviewed CT examinations for appendiceal-related findings...
September 2015: AJR. American Journal of Roentgenology
A Prokop, R Dolezych, M Chmielnicki
BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the therapy of choice. We want to demonstrate the operation technique of implantation of a hemiprosthesis (dual head prosthesis) by video in an 87-year-old female patient. In addition, we analyse the long-term results after surgery more than one year after endoprosthesis in patients with femoral neck fractures. METHOD: From 2007 to 2010, 219 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital...
June 2015: Zeitschrift Für Orthopädie und Unfallchirurgie
Matthew E Arnold, Lucinda Buys, Fekadu Fullas
OBJECTIVE: The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate...
June 1, 2015: American Journal of Health-system Pharmacy: AJHP
Leslie Harrold, Scott Pascal, Courtland Lewis, Regis O'Keefe, Vincent Pellegrini, Jeroan Allison, David Ayers, Patricia Franklin
INTRODUCTION: Current approaches to quantifying total posthospital complications and readmissions following surgical procedures are limited because the United States does not have a single health care payer. Patients seek posthospital care in varied locations, yet hospitals can only quantify those returning to the same facility. Seeking information directly from patients about health care utilization following hospital discharge holds promise to provide data that is missing for surgeons and health care systems...
2014: EGEMS
Anuwat Pongkunakorn, Duangrak Sawatphap
BACKGROUND: There are variations in the type of rehabilitation program and duration of using the continuous passive motion (CPM) machine to increase range of motion (ROM) following total knee arthroplasty (TKA). OBJECTIVE: To compare the outcomes of the 'drop and dangle' (D&D) protocol vs. a 3-hour daily CPM for the purpose of increasing flexion following TKA. MATERIAL AND METHOD: A prospective non-concurrent controlled intervention study was conducted on patients who underwent primary TKA atLampang Hospital from December 2009 to August 2011 (D&D group, n = 36) andfrom September 2011 to December 2012 (CPM group, n = 33)...
September 2014: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Diego Costa Astur, Vinicius Aleluia, Ciro Veronese, Nelson Astur, Saulo Gomes Oliveira, Gustavo Gonçalves Arliani, Ricardo Badra, Camila Cohen Kaleka, Joicemar Tarouco Amaro, Moisés Cohen
BACKGROUND: Current literature supports the thought that anesthesia and analgesia administered perioperatively for an anterior cruciate ligament (ACL) reconstruction have a great influence on time to effective rehabilitation during the first week after hospital discharge. PURPOSE: The aim of this study is to answer the research question is there a difference in clinical outcomes between the use of a femoral nerve block with spinal anesthesia versus spinal analgesia alone for people undergoing ACL reconstruction? METHODS: ACL reconstruction with spinal anesthesia and patient sedation (Group one); and spinal anesthesia with patient sedation and an additional femoral nerve block (Group two)...
October 2014: Knee
R Hlubek, P Walder, J Káňa, D Salounová
PURPOSE OF THE STUDY: Surgical incision closure, as well as total joint replacement itself, plays a key role in the overall outcome of an arthroplasty procedure. Uncomplicated wound healing is the essential condition of successful rehabilitation and the patient's return to normal activities. Although there are many innovative suturing techniques which offer advantages, their safety is still being discussed. The aim of this prospective non-blind randomised study was to evaluate wound healing and complications in relation to skin incision closure with either conventional suture or metal staples...
2014: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Ian Starks, Thomas W Wainwright, Jenny Lewis, John Lloyd, Robert G Middleton
BACKGROUND: Between August 2007 and May 2009, 2128 consecutive patients underwent either primary hip or knee joint replacement surgery at our institute on an enhanced recovery pathway. We aimed to investigate the potential benefits of this pathway in patients over the age of 85 years. METHODS: Data extracted from Hospital Episode Statistics were analysed. This data are prospectively collected and independently collated. RESULTS: In all patients median length of stay was reduced when compared with both our own data before the introduction of the pathway (6 to 4 days) and national averages over the same time period for both hip and knee replacements (5 to 4 days)...
September 2014: Age and Ageing
A Prokop, F Fröhlich, R Dolezych, M Chmielnicki
BACKGROUND: In geriatric patients with Pauwels II and III type femoral neck fractures, endoprosthesis is the treatment of choice. PURPOSE: What are the long-term results after surgery? MATERIALS AND METHODS: In 2007 and 2008, 104 public health insurance (AOK) patients with displaced femoral neck fractures were treated surgically at our hospital. This number of included patients places us in the 97th percentile of all hospitals in Germany. Because the patients were publicly insured, all health information was available, including completely retrospective posthospital discharge, inpatient course, and 1-year mortality...
November 2014: Zeitschrift Für Gerontologie und Geriatrie
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