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Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.

Publication ,  Journal Article
Ryan, SP; Howell, CB; Wellman, SS; Attarian, DE; Bolognesi, MP; Jiranek, WA; Aronson, S; Seyler, TM
Published in: J Arthroplasty
July 2019

BACKGROUND: The Comprehensive Care for Joint Replacement (CJR) model has resulted in the evolution of preoperative optimization programs to decrease costs and hospital returns. At the investigating institution, one center was not within the CJR bundle and has dedicated fewer resources to this effort. The remaining centers have adopted an 11 metric checklist designed to identify and mitigate modifiable preoperative risks. We hypothesized that this checklist would improve postoperative metrics that impact costs for total knee arthroplasty (TKA) patients eligible for participation in CJR. METHODS: Patients undergoing TKA from 2014 to 2018 were retrospectively reviewed. Only patients with eligible participation in CJR were included. Outcome variables including length of stay, disposition, 90-day emergency department visits, and hospital readmissions were explored. Analysis was performed to determine differences in outcomes between CJR participating and non-CJR participating hospitals within the healthcare system. RESULTS: In total, 2308 TKA patients including 1564 from a CJR participating center and 744 from a non-CJR center were analyzed. There was no significant difference in patient age or gender. Patients at the non-CJR hospital had significantly higher body mass index (P < .001) and American Society of Anesthesiologists scores (P < .001), while those in the CJR network had fewer skilled nursing facility discharges (P = .028) and shorter length of stay (P < .001). However, there was no reduction in 90-day emergency department visits or readmissions. CONCLUSION: The resources utilized at CJR participating hospitals, including patient optimization checklists, did not effectively alter patient outcomes following discharge. Likely, a checklist alone is insufficient for risk mitigation and detailed optimization protocols for modifiable risk factors must be investigated.

Duke Scholars

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2019

Volume

34

Issue

7S

Start / End Page

S108 / S113

Location

United States

Related Subject Headings

  • Skilled Nursing Facilities
  • Retrospective Studies
  • Perioperative Period
  • Patient Readmission
  • Patient Discharge
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Joint
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ryan, S. P., Howell, C. B., Wellman, S. S., Attarian, D. E., Bolognesi, M. P., Jiranek, W. A., … Seyler, T. M. (2019). Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty. J Arthroplasty, 34(7S), S108–S113. https://doi.org/10.1016/j.arth.2018.12.010
Ryan, Sean P., Claire B. Howell, Samuel S. Wellman, David E. Attarian, Michael P. Bolognesi, William A. Jiranek, Solomon Aronson, and Thorsten M. Seyler. “Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.J Arthroplasty 34, no. 7S (July 2019): S108–13. https://doi.org/10.1016/j.arth.2018.12.010.
Ryan SP, Howell CB, Wellman SS, Attarian DE, Bolognesi MP, Jiranek WA, et al. Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty. J Arthroplasty. 2019 Jul;34(7S):S108–13.
Ryan, Sean P., et al. “Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty.J Arthroplasty, vol. 34, no. 7S, July 2019, pp. S108–13. Pubmed, doi:10.1016/j.arth.2018.12.010.
Ryan SP, Howell CB, Wellman SS, Attarian DE, Bolognesi MP, Jiranek WA, Aronson S, Seyler TM. Preoperative Optimization Checklists Within the Comprehensive Care for Joint Replacement Bundle Have Not Decreased Hospital Returns for Total Knee Arthroplasty. J Arthroplasty. 2019 Jul;34(7S):S108–S113.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

July 2019

Volume

34

Issue

7S

Start / End Page

S108 / S113

Location

United States

Related Subject Headings

  • Skilled Nursing Facilities
  • Retrospective Studies
  • Perioperative Period
  • Patient Readmission
  • Patient Discharge
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Joint
  • Humans