Preoperative medical evaluation at perioperative clinic decreases length of stay after TJA
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Key takeaways:
- Preoperative medical evaluation at a perioperative clinic decreased length of stay after total joint arthroplasty vs. usual care.
- No differences were found in patient-reported outcomes between the groups.
Patients who received a preoperative medical evaluation at a perioperative medical clinic within 30 days of total joint arthroplasty had decreased length of stay with no effect on patient-reported outcomes, according to published data.
Rakesh R. Veerareddy, MBBS, and colleagues at Dartmouth Health compared outcomes of patients undergoing primary total hip or knee arthroplasty who received a preoperative medical evaluation at a perioperative medical clinic compared with patients who received usual care.
“A perioperative surgical home, with anesthesiologists as the perioperative care providers, or perioperativists, could integrate perioperative care and address avoidable harm to the surgical patient that results from fragmented care,” the researchers wrote.
Overall, 1,911 of 2,322 patients (82.3%) received preoperative medical evaluation for TKA and 1,876 of 2,541 patients (73.8%) received preoperative medical evaluation for THA.
Outcome measures included length of stay and patient-reported outcomes measurement information system-10 global physical health (PROMIS-10 GPH) scores.
Veerareddy and colleagues found patients who received preoperative medical evaluation at a perioperative medical clinic had a lower mean length of stay for TKA (43.46 hours vs. 54.15 hours) and THA (41.07 hours vs. 57.94 hours) compared with patients who received usual care. Rates of extended length of stay were also lower for patients who received preoperative medical evaluation at a perioperative medical clinic compared with patients who received usual care for TKA (15% vs. 26.5%) and THA (13.3% vs. 27.4%). In addition, researchers found no differences in improvements of PROMIS-10 GPH scores between the groups.
“The focus of the perioperativists on TJA helped to achieve these goals in the [preoperative medical evaluation] group; in contrast, the usual care group received care from a diverse group of providers with varied skill sets that were neither unique to perioperative care nor unique to TJA,” the researchers wrote.
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