Counseling, education prior to TJA may improve outcomes in high-risk patients
Click Here to Manage Email Alerts
Published results showed high-risk patients who received individualized nurse navigator counseling and education prior to undergoing total joint arthroplasty experienced similar outcomes to the broader patient population.
“This study demonstrates that, when provided with appropriate resources, such as nurse navigator counseling and education, high-risk patients can achieve similar outcomes to the general lower-risk population undergoing TJA,” Justin J. Turcotte, PhD, MBA, told Healio. “Further, the use of the nurse navigator-led [enhanced preoperative education pathway] program mitigated disparities between African American and non-African American patients.”
Turcotte and colleagues compared demographics, comorbidities and outcomes of 1,716 patients who underwent unilateral primary total hip or knee arthroplasty between Sept. 1, 2020, and Sept. 31, 2021, and were treated through either an enhanced preoperative education pathway program (n=802) or routine care (n=914). Researchers also performed a subgroup analysis of outcome differences by race.
Results showed patients in the enhanced preoperative education pathway program had a higher comorbidity burden as measured by the Charlson Comorbidity Index. Although risk adjustment showed no significant relationship between utilization of an enhanced preoperative education pathway program and length of stay, home discharge or 30-day readmissions, researchers found patients who went through the education program were less likely to return to the ED 30 days postoperatively. Researchers did not observe significant differences in outcomes between African American patients and patients who were not African American.
“By tailoring preoperative education and support programs based on level of risk, we may improve the equity of care delivered across populations,” Turcotte said. “Increased adoption of programs, such as the one described [in the study], is feasible using resources already available at many institutions and may help reduce disparities in orthopedic patients.”
Perspective
Back to Top
It is clear that there are significant disparities in the delivery of total joint replacement care in the United States. Many studies have demonstrated specific racial and socioeconomic groups to be at risk for poor outcomes after surgery. One important part of the joint replacement pathway is preoperative education — joint classes, handouts and in-person discussion. This intervention exists to set expectations and has been shown to decrease anxiety, length of stay and readmissions. This preoperative education serves as another example of the disparities in joint replacement delivery, as specific groups are less likely to attend education class.
Although these differences in outcomes and delivery are well-known, they have persisted over time, making it clear that strategies to improve results for at-risk groups have limited success.
The study authors retrospectively reviewed their experience with an “enhanced preoperative education pathway,” which involved distribution of written and video educational products, as well as personal interaction with their dedicated nurse navigator. They found that pathway patients had similar lengths of stay, rates of home discharge, 30-day readmission and lower 30-day ED utilization compared with the non-pathway group, despite carrying a higher medical comorbidity burden.
This study certainly highlights the importance of preoperative education in the medically comorbid population to mitigate poor outcomes. An important next step would be prospectively analyzing this or similar enhanced protocols in other at-risk groups — particularly racial and socioeconomic groups that have been shown to have suboptimal outcomes after total joint replacement.
Collapse
Read more about
Click Here to Manage Email Alerts