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TKA performed at orthopedic specialty hospital yielded outcomes similar to tertiary referral center
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Patients who underwent total knee arthroplasty at an orthopedic specialty hospital experienced perioperative outcomes similar to patients who underwent TKA at a tertiary referral center, according to results published in Orthopedics.
According to demographic and clinical variables, Eric M. Padegimas, MD, and colleagues matched 215 patients undergoing primary TKA at an orthopedic specialty hospital with 215 patients undergoing primary TKA at a tertiary referral center. Outcomes included 90-day readmission, mortality rate, reoperation, length of stay and use of inpatient rehabilitation.
Results showed a mean length of stay of approximately 1.47 days and 1.87 days among patients in the orthopedic specialty hospital and the tertiary referral center, respectively. Researchers found three readmissions and six reoperations at the orthopedic specialty hospital vs. six readmissions and five reoperations at the tertiary referral center. Inpatient rehabilitation was used by eight patients at the orthopedic specialty hospital compared with 15 patients at the tertiary referral center. Researchers noted the transfer of one patient treated at the orthopedic specialty center to a tertiary referral center.
“After matching for age, gender, body mass index and medical comorbidities, the average length of stay was 0.4 days shorter per patient at the orthopedic specialty hospital when compared to the tertiary referral center,” Padegimas told Healio.com/Orthopedics. “This equals 2 fewer hospital nights for every five total knee arthroplasty patients treated. There was no difference in other perioperative outcomes such as 90-day readmission rate, reoperation or mortality. These findings suggest that utilization of an orthopedic specialty hospital may lead to a decreased length of stay in carefully selected total knee arthroplasty patients.” – by Casey Tingle
Disclosures: Padegimas reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Jack M. Bert, MD
This article confirms what has been published over the past 10 years, ie that procedures performed in orthopedic specialty hospitals do as well if not better than those in a general hospital environment. Furthermore, rapid mobilization is critical to allow for rapid recovery and this article confirms that the key to success with any surgical procedure, especially total joints, is preoperative patient selection and patient optimization. Utilizing strict screening criteria — as noted under tables 1 and 2 — specifically targeting multiple exclusion comorbidities and identifying patient demographics and clinical variables resulted in the ability for the surgeon to objectively predetermine which patients have a higher likelihood for re-admissions and complications. Identifying comorbidities prior to considering surgical intervention allows the surgeon to optimize patients who clearly need surgery to dramatically reduce complication and readmission rates. The comparison of 17 comorbidity variables of the Charlson Comorbidity Index clearly confirms the advantages of utilizing quality metrics which resulted in zero perioperative mortality rates, readmission rates and reoperation rates either at an orthopedic specialty hospital or a tertiary referral center. Thus, this article justifies doing procedures essentially at any location with excellent results when controlling for preoperative demographic and medical variables and optimizing patients as necessary prior to surgical intervention.
The specific advantages of the specialty hospital were primarily related to the efficiency and subspecialty training of the orthopedic staff, as well as cost reduction due to a decreased length of stay. However, the authors did emphasize the critical nature of patient selection using thorough screening tools and patient optimization protocols to avoid operating on patients that result in a higher incidence of readmission and complications. These conclusions beg the question of “Shouldn’t we be doing this with all of our total joint patients prior to surgical intervention?”
References:
Bert JM, et al. Curr Rev Musculoskelet Med. 2017;doi:10.1007/s12178-017-9451-2.
Cram P, et al. J Bone Joint Surg Am. 2007;doi:10.2106/JBJS.F.00873.
Malviya A, et al. Acta Orthop. 2011;doi:10.3109/17453674.2011.618911.
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