Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2016; 7(6): 376-382
Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.376
Joint arthroplasty Perioperative Surgical Home: Impact of patient characteristics on postoperative outcomes
Duy L Phan, Kyle Ahn, Joseph B Rinehart, Michael-David Calderon, Wei-Der Wu, Ran Schwarzkopf
Duy L Phan, Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA 92868, United States
Kyle Ahn, Joseph B Rinehart, Michael-David Calderon, Wei-Der Wu, Department of Anesthesiology, University of California, Irvine Medical Center, Orange, CA 92868, United States
Ran Schwarzkopf, Division of Adult Reconstruction, Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY 10279, United States
Author contributions: Phan DL wrote and revised the manuscript; Ahn K and Schwarzkopf R designed the research study, performed data collection and revised the manuscript; Rinehart JB designed the research study, performed data collection and statistical analysis, and revised the manuscript; Calderon MD and Wu WD performed data collection and statistical analysis.
Institutional review board statement: The study was reviewed and approved by the University of California, Irvine Institutional Review Board.
Informed consent statement: Informed consent was waived by the IRB.
Conflict-of-interest statement: Dr. Phan has no relevant disclosures to make in relation to the submitted study. Dr. Phan has not received research funding, speaker fees, consulting fees, or royalties from any organizations. Dr. Phan is an employee of the Department of Orthopaedic Surgery, University of California, Irvine Medical Center. Dr. Phan does not own company stock or options. Dr. Phan does not own any patents. Dr. Phan is not on the editorial board of any journals. Dr. Phan is not a board member of any societies. Dr Schwarzkopf has a conflict of interest with Smith&Nephew, Intelijoint, Gauss Surgical.
Data sharing statement: All technical data is available from the corresponding author at schwarzk@gmail.com. Consent was not obtained for data sharing but the presented data is anonymized and the risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ran Schwarzkopf, MD, MSc, Assistant Professor, Division of Adult Reconstruction, Department of Orthopaedic Surgery, New York University Langone Medical Center, 301 East 17th Street, New York, NY 10279, United States. schwarzk@gmail.com
Telephone: +1-212-5137711
Received: February 10, 2016
Peer-review started: February 14, 2016
First decision: March 1, 2016
Revised: March 7, 2016
Accepted: March 24, 2016
Article in press: March 25, 2016
Published online: June 18, 2016
Processing time: 123 Days and 23.3 Hours
Abstract

AIM: To determine the impact of different characteristics on postoperative outcomes for patients in a joint arthroplasty Perioperative Surgical Home (PSH) program.

METHODS: A retrospective review was performed for patients enrolled in a joint arthroplasty PSH program who had undergone primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients were preoperatively stratified based on specific procedure performed, age, gender, body mass index (BMI), American Society of Anesthesiologists Physical Classification System (ASA) score, and Charleston Comorbidity Index (CCI) score. The primary outcome criterion was hospital length of stay (LOS). Secondary criteria including operative room (OR) duration, transfusion rate, Post-Anesthesia Care Unit (PACU) stay, readmission rate, post-operative complications, and discharge disposition. For each outcome, the predictor variables were entered into a generalized linear model with appropriate response and assessed for predictive relationship to the dependent variable. Significance level was set to 0.05.

RESULTS: A total of 337 patients, 200 in the TKA cohort and 137 in the THA cohort, were eligible for the study. Nearly two-third of patients were female. Patient age averaged 64 years and preoperative BMI averaged 29 kg/m2. The majority of patients were ASA score III and CCI score 0. After analysis, ASA score was the only variable predictive for LOS (P = 0.0011) and each increase in ASA score above 2 increased LOS by approximately 0.5 d. ASA score was also the only variable predictive for readmission rate (P = 0.0332). BMI was the only variable predictive for PACU duration (P = 0.0136). Specific procedure performed, age, gender, and CCI score were not predictive for any of the outcome criteria. OR duration, transfusion rate, post-operative complications or discharge disposition were not significantly associated with any of the predictor variables.

CONCLUSION: The joint arthroplasty PSH model reduces postoperative outcome variability for patients with different preoperative characteristics and medical comorbidities.

Keywords: Perioperative Surgical Home; Arthroplasty; Length of stay; American Society of Anesthesiologists Physical Classification System; Body mass index

Core tip: The Perioperative Surgical Home (PSH) model is designed to improve healthcare delivery and reduce medical costs. In this study, patients in a joint arthroplasty PSH program were stratified based on preoperative characteristics and comorbidities to determine if these variables would impact postoperative results. Our results suggest that a joint arthroplasty PSH program may improve postoperative consistency and limit the influence of different patient attributes on surgical outcome. Arthroplasty patients with preoperative characteristics traditionally considered risk factors for negative outcomes, such as a high body mass index or an elderly age, may benefit from enrollment in a PSH program.