A Total Knee Arthroplasty Preoperative Optimization Program Managed by an Advanced Practice Provider (Physician Assistant) Decreases Complications and Cost: A Pilot Study.

BACKGROUND: Studies have shown that optimizing modifiable risk factors leads to improved outcomes, with decreased lengths of stay (LOS), readmissions, complications, and hospital costs. Our goal was to demonstrate that use of an advanced practice provider, physician assistant (PA), within an orthopaedic practice would support these outcomes. METHODS: A preoperative optimization program managed by a PA was instituted at an academic medical center. From November 2019 to December 2022, a pilot group of fifteen (15) consecutive primary total knee arthroplasty (TKA) patients who were successfully optimized with the PA-managed program prior to TKA were matched 2:1 to a cohort of thirty (30) TKA patients who did not undergo optimization. Demographics and the modified readmission risk assessment tool score were used to match patients. Variables evaluated included LOS, emergency department visits, and hospital readmissions within 30 and 90 days after surgery, complications, and hospital costs of care. RESULTS: Optimized patients had less complications (P = .004) and significantly shorter (P < .001) mean LOS (1.27 days vs 2.97 days) compared to nonoptimized patients. The difference of hospital cost between cohorts for the primary admission was significant (P = .049). When readmission costs were included, the average hospital cost for the nonoptimized group was significantly higher than the optimized group (P = .018). CONCLUSIONS: Preoperative optimization led by a PA demonstrated significant reductions in LOS and the costs of care between optimized and non-optimized patients, along with decreased complications.

Telemedicine Hip and Knee Arthroplasty Experience During COVID-19.

BACKGROUND: Although telemedicine visits were essential and adopted by providers and patients alike, few studies have been conducted evaluating orthopedic patient perception of the care delivered during these visits. To our knowledge, no study has evaluated specific factors that affected patient satisfaction with telemedicine and the receptiveness to continue virtual visits post COVID-19 in total joint arthroplasty (TJA) patients. Thus, the purposes of our study are to determine the following: (1) patient satisfaction with using TJA telemedicine services, (2) whether patient characteristics might be associated with satisfaction, and (3) whether virtual clinic visits may be used post-COVID-19. METHODS: A prospective, cross-sectional survey study was completed by 126 TJA patients who participated in telemedicine visits with TJA surgeons from May 1, 2020 to August 31, 2020. The survey consisted of questions regarding demographics, satisfaction, and telemedicine experiences. RESULTS: One hundred one (80.2%) patients were satisfied with their telemedicine visit, with patients <80 years old (P = .008) and those with a longer commute time (P = .01) being more satisfied P = .01. There was a significant preference for in-person visits when meeting arthroplasty surgeons for the first time (P < .001), but patients were equally amenable to follow-up telemedicine visits once there was an established relationship with the surgeon. CONCLUSION: Younger patients, patients with longer commute distances, and patients who had established relationships with their provider expressed higher satisfaction with telemedicine arthroplasty visits. Although >80% of patients were satisfied with their telemedicine visit, an established patient-provider relationship may be integral to the success of an arthroplasty telemedicine practice.