Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.376
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
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.
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.