Patients with familial primary emergency contact may have improved outcomes after TJA
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Key takeaways:
- Patients with a familial emergency contact demonstrated better outcomes after surgery vs. patients with a non-familial emergency contact.
- Familial contacts include a spouse and first- or second-degree relative.
Published results showed patients with a familial emergency contact, such as a spouse or first- and second-degree relative, may have better outcomes after total hip or knee arthroplasty vs. patients with a non-familial emergency contact.
Casey Cardillo, BS, research fellow from the department of orthopedic surgery at NYU Langone Health, and colleagues performed a retrospective review of data from 17,520 THAs and 20,397 TKAs that were performed at a single institution between June 2011 and December 2022.
Cardillo and colleagues assessed the impact of familial vs. non-familial primary emergency contacts on outcomes. According to the study, familial emergency contacts were defined as a spouse or first- and second-degree relative, while non-familial emergency contacts were defined as a friend or neighbor.
Among the THA cohort, 16,123 (92%) primary emergency contacts were familial and 1,397 (8%) were not. Among the TKA cohort, 18,819 (92.3%) primary emergency contacts were familial and 1,578 (7.7%) were not.
At 2-year follow-up, Cardillo and colleagues found a non-familial emergency contact was associated with an increased risk of all-cause revision for both THA (OR = 1.48) and TKA (OR = 1.62) compared with a familial emergency contact. In addition, they found patients with a familial emergency contact had significantly decreased length of stays and increased rates of home discharges vs. patients with a non-family emergency contact for both THA and TKA.
“Informal caregivers, often family members or close friends, undertake various responsibilities, including assistance with daily activities, medication management, wound care and emotional support,” Cardillo and colleagues wrote in the study. “Moreover, they act as intermediaries between patients, the health care team and community resources, facilitating follow-up appointments, arranging transportation and navigating recovery challenges.”
Perspective
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During the last decade or so, we have gained increasing awareness of the importance of understanding the social determinants of health and its implications on outcomes after hip and knee arthroplasty. The transition to shorter hospital stays and ambulatory hip and knee replacement have further highlighted this importance. This study uses non-familial primary contacts as a proxy for a patient’s lack of any direct relatives available to assist with care immediately following surgery. While this may not be perfectly accurate, it appears a reasonable way to evaluate the subject and provides some fascinating, albeit not unexpected, results.
The fact that patients with a non-family primary contact have inferior clinical outcomes (measured in terms of need for revision surgery, longer hospital stays and non-home discharge) highlights the critical impact that a patient’s social support system has on the patient’s outcome after their hip or knee replacement surgery. As surgeons, we can use this information to design tailored patient questions prior to surgery; and, as a health care system, this demonstrates the value of post-discharge care services in this higher-risk patient population.
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