Perioperative Outcomes and Complications After Primary Total Hip Arthroplasty in Patients With Disproportionately Short Stature: A Matched Cohort Analysis.

BACKGROUND: This study compared (1) perioperative outcomes, (2) postoperative complications, and (3) reoperation rates after primary total hip arthroplasty (THA) between short stature patients and matched control patients. METHODS: A review of primary THA patients from 2012 to 2017 using an institutional database was conducted. This yielded 12,850 patients of which 108 were shorter than 148 cm. These patients were matched 1:1 by age (P = .527), gender (P = .664), and body mass index (P = .240) to controls. The final study population with minimum 1-year follow-up that was included for analysis comprised 47 patients in the short stature cohort and 57 patients in the control cohort. The following outcomes/complications were compared: operative times, lengths of stay (LOSs), intraoperative fractures, minor complications, 90-day readmissions, and revisions. RESULTS: Operative times were significantly longer in the short stature cohort than in the matched control cohort (133 ± 65 minutes vs 104 ± 30 minutes, P = .005). In addition, hospital LOS was slightly longer in the short stature group than in the matched control groups (3.2 ± 1.5 days vs 2.6 ± 1.0, P = .017). Rates of intraoperative fractures (P = 1.000), minor complications P = .406), 90-day readmissions (P = .5000), and revision (P = .202) were similar between the short stature and control cohorts. CONCLUSION: Patients with disproportionately short stature had longer operative times and slight longer LOS. However, complication and readmission rates were similar. Future studies with larger sample sizes are warranted to confirm these findings and further evaluate implant survivorship in this unique THA patient population.

Data Sharing Between Providers and Quality Initiatives Eliminate Unnecessary Nursing Home Admissions.

BACKGROUND: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) has monitored discharge disposition, after total hip and knee arthroplasties, since inception in 2012 and found the standardized risk of extended care facility (ECF) placement to be highly variable between hospitals. METHODS: The variation in standardized risks of ECF placement among MARCQI member sites was reported to the collaborative. At the May 2, 2014 quarterly meeting, a quality initiative was started, emphasizing the wide variability between hospitals, the contribution of hospital and surgeon to that variability using median odds ratios, and the need for outlier hospitals to initiate quality improvement (QI) processes. Patients from 29 hospitals that were members of MARCQI before the intervention were included in this analysis. We compared standardized risks before and after the intervention in the entire cohort, and for 3 hospitals that implemented institution-specific QI projects. We report changes in ECF placement, length of stay, emergency room visits, and readmissions over time. RESULTS: This study includes 31,347 patients before and 20,879 patients after the implementation of the quality initiative. The range in standardized risk dropped from 9.4%-46.1% to 9.4%-32.4% and the average dropped from 23.0% to 19.6%. Three outlier hospitals decreased their absolute risk of ECF placement by 12.2%, 8.9%, and 12.4% after QI, without increases in adverse outcomes. CONCLUSION: Discharge to ECF after primary hip and knee arthroplasties is highly variable and influenced by hospital and surgeon practices. Hospital-level QI measures can decrease ECF admissions.