RESUMO
Background: Unplanned calls, messages, and visits to the clinic can occur at a higher rate as newer technologies allow patients more accessibility and connectivity to clinicians. By reviewing postoperative patient phone calls and electronic portal messages, we compared the methods and frequency of communications between conventional and robotic joint arthroplasty cases. Methods: A retrospective review of total hip, total knee, and unicompartmental knee arthroplasty procedures by fellowship-trained adult reconstruction surgeons at our hospitals between 2017 and 2022 was performed. Any unplanned postoperative communication within 30 days of the postoperative period and unplanned emergency department visits were collected. Results: There were 12,300 robotic and manual consecutive primary total hip, total knee, and unicompartmental knee arthroplasty procedures performed on 10,908 patients over the study period. A total of 905 (40.4%) patients and 2012 (23.2%) patients sent an electronic text message (ETM) in the robotic and manual arthroplasty cohorts (P < .0001), respectively. Overall, 1942 (86.6%) patients in the robotic arthroplasty group and 6417 (74%) patients in the manual arthroplasty group had at least one phone call within the first month after their joint arthroplasty. Conclusions: Robotic arthroplasty patients place an increased demand on the orthopaedic surgery department in terms of unplanned patient contacts. Robotic arthroplasty patients had a significantly increased rate of unplanned postoperative ETMs and phone calls when compared to manual arthroplasty patients. An increased number of postoperative phone calls, but not ETMs, can also be indicative of an emergency department visit. These findings can be used in the perioperative setting to counsel and educate patients about expectations.
RESUMO
Introduction: Increasing incidence of fragility fractures has spurred development of protocols, largely focused on peri-operative care, with numerous proven benefits. The purpose of this investigation was to evaluate outcomes of our hip fracture treatment program regarding successful protocol implementation, compliance, effect on subsequent fracture rates, and mortality during the first decade of adoption. Methods: A retrospective review identified patients >65 years old with fragility hip fractures between 2010 and 2022. The HiROC (+) cohort consisted of patients who received a "High-Risk Osteoporosis Clinic" (HiROC) referral for bone health evaluation and bisphosphonate initiation as indicated. Additional fracture rates and mortality at 3 years were calculated. Protocol implementation and compliance over the first 10 years was analyzed in the four identified cohorts. Results: A total of 1671 fragility hip fractures were identified, with 386 excluded due to insufficient follow-up, with an average age of 81.6 years and a median follow-up of 36.4 months. Of the 1280 included cases, 56% (n = 717) had a HiROC referral placed. HiROC(+) groups had lower subsequent fracture rates at two years, compared to those without referral (28% vs 13%, P < 0.0001) and those completing more steps of the protocol had lower subsequent fracture rates (28% vs 15% vs 13% vs 5%, P < 0.0001). No statistically significant difference was observed between the cohorts for anatomic site of subsequent fractures. Discussion: Greater than half of all eligible patients were successfully captured by the protocol. Patients completing more steps of the protocol had lower subsequent fracture rates. Captured patients demonstrated reduced mortality rates when compared to current literature. Conclusion: Successful implementation of this geriatric hip fracture protocol was associated with reduced additional fractures and mortality rates. Identifying steps of process failures in the protocol can provide opportunities for increased compliance and reduction in future fracture occurrences.