Trends in the Adoption of Outpatient Joint Arthroplasties and Patient Risk: A Retrospective Analysis of 2019 to 2021 Medicare Claims Data.

INTRODUCTION: Total joint arthroplasties (TJAs) have recently been shifting toward outpatient arthroplasty. This study aims to explore recent trends in outpatient total joint arthroplasty (TJA) procedures and examine whether patients with a higher comorbidity burden are undergoing outpatient arthroplasty. METHODS: Medicare fee-for-service claims were screened for patients who underwent total hip, knee, or shoulder arthroplasty procedures between January 2019 and December 2022. The procedure was considered to be outpatient if the patient was discharged on the same date of the procedure. The Hierarchical Condition Category Score (HCC) and the Charlson Comorbidity Index (CCI) scores were used to assess patient comorbidity burden. Patient adverse outcomes included all-cause hospital readmission, mortality, and postoperative complications. Logistic regression analyses were used to evaluate if higher HCC/CCI scores were associated with adverse patient outcomes. RESULTS: A total of 69,520, 116,411, and 41,922 respective total knee, hip, and shoulder arthroplasties were identified, respectively. Despite earlier removal from the inpatient-only list, outpatient knee and hip surgical volume did not markedly increase until the pandemic started. By 2022Q4, 16%, 23%, and 36% of hip, knee, and shoulder arthroplasties were discharged on the same day of surgery, respectively. Both HCC and CCI risk scores in outpatients increased over time ( P < 0.001). DISCUSSION: TJA procedures are shifting toward outpatient surgery over time, largely driven by the COVID-19 pandemic. TJA outpatients' HCC and CCI risk scores increased over this same period, and additional research to determine the effects of this should be pursued. LEVEL OF EVIDENCE: Level III, therapeutic retrospective cohort study.

Scheduling and Vendor Consistency Improves Turnover Time Efficiency in Total Joint Arthroplasty.

BACKGROUND: Maximizing operative room (OR) efficiency is important for hospital efficiency, patient care, and positive surgeon and staff morale. Reducing turnover time (TOT) has become a popular focus to improve OR efficiency. The present study evaluated if TOT is influenced by changing case type, implant vendor, and/or laterality. METHODS: In total, 444 turnovers from January to July 2023 were retrospectively analyzed. All turnovers were same-surgeon turnovers between primary arthroplasty cases in dedicated, overlapping rooms. Single linear regression models tested the predictability of TOT based on case type, vendor, and laterality. A multivariate multiple regression and 1-way Analyses of Variance analyzed variables against each other. Independent sample t-tests evaluated TOTs when all variables were the same or different. RESULTS: Changing versus keeping the same case type increased TOT by 2.4 minutes (95% confidence interval [CI] = 0.7, 4.0; P = .004). Changing vendors increased TOT by 2.9 minutes (95% CI = 1.1, 4.7; P = .002). Laterality did not affect TOT, with a change of 0.9 minutes (95% CI = -0.6, 2.5; P = .229). Vendor (P = .030) independently predicted TOT when analyzed as a covariate with case type (P = .410). The TOT with same case type and vendor (mean 38.2 minutes; range, 22 to 62) was less than that of different case types and vendors (mean 41.4 minutes; range, 26 to 73) (P = .017). Mean TOT differed by 5.5 minutes when keeping all variables the same versus all different (P = .018). CONCLUSIONS: Maintaining a consistent case type, vendor, and laterality had a synergistic effect in reducing TOT in arthroplasty ORs with the same primary surgeon running 2 overlapping rooms. Changing vendor representatives was found to independently predict TOT increases, which is likely attributed to a disruption in workflow and collaboration of the multidisciplinary OR team. LEVEL OF EVIDENCE: Level III.

Models of healthcare delivery for osteoarthritis / Modelos de prestación de asistencia sanitaria para la artrosis

No disponible

Enfermedad tromboembólica en cirugía ortopédica y traumatismos no quirúrgicos / Thromboembolic disease in orthopaedic surgery and non-surgical trauma

No disponible

Registro Andaluz de Artroplastias / Andalusian arthroplasty registry

No disponible

Registro de artroplastias de Andalucía / Andalusia Arthroplasty register

No disponible

Validación de una escala reducida de capacidad funcional del cuestionario WOMAC / Validation of a short form of the function dimension of the WOMAC questionnaire

Objetivos El objetivo del estudio fue evaluar la validez, la fiabilidad y la sensibilidad al cambio de la versión española de la dimensión reducida de 7 ítems de capacidad funcional del Western Ontario McMaster Universities Osteoarthritis Index (WOMAC). Métodos Estudio prospectivo con seguimiento de 1 año realizado con 459 pacientes en lista de espera para prótesis de cadera o rodilla. Se enviaron los cuestionarios WOMAC y EQ-5D en cuatro tiempos: basal, 3, 6 y 12 meses postintervencion. Se realizó el proceso de validación, análisis Rasch y acuerdo medido por el gráfico de Bland-Altman. Resultados Los valores de los coeficientes rho de Spearman y de concordancia de Lin entre la versión completa y la reducida estuvieron entre 0,96 y 0,98. Se encontraron diferencias estadísticamente significativas (p<0,001) entre los tres grupos de gravedad medidos por una pregunta del EQ-5D. Ambos gráficos de Bland-Altman mostraron que no había diferencias sistemáticas y que las diferencias entre ambas escalas no dependen de la gravedad. La escala reducida se ajusta al modelo Rasch. Los valores α de Cronbach fueron superiores a 0,85. El estudio de la sensibilidad al cambio dio valores superiores a 1,27 en la prótesis total de rodilla y a 1,72 en la de cadera. Conclusiones La versión española de la escala reducida de capacidad funcional del WOMAC es válida, fiable y sensible al cambio en los pacientes con remplazo articular. Su uso disminuirá la carga de los pacientes, tanto en estudios como en la práctica clínica(AU)

Objective The aim of this prospective study was to evaluate the validity, reliability and responsiveness of the Spanish version of the 7-item short-form of the function dimension of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Methods We conducted a prospective 1-year cohort study that included 459 patients on the waiting list for total knee or hip replacement. The WOMAC and EQ-5D questionnaires were sent at four time points: baseline and at 3, 6 and 12 months post-surgery. Based on a previously shortened scale, we performed a validation process with Rasch analysis and agreement measured by Bland-Altman plots. Results The values of Spearman's rho and Lin concordance coefficients between the full and short-form ranged from 0.96 to 0.98. Differences were statistically significant (p<0.001) among the three groups of severity measured by a item in the EQ-5D. The two Bland-Altman plots showed no systematic differences and agreement was not dependent on the severity score. The short form fitted the Rasch model. Cronbach's α coefficients were higher than 0.85. Responsiveness was higher than 1.27 and 1.72 in knee and hip replacement, respectively. Conclusions The Spanish 7-item short form of the WOMAC function dimension is valid, reliable and responsive for patients with total joint replacement. The use of this version will reduce the burden on patients in both clinical studies and clinical practice (AU)