National Institute of Health and Care Excellence (NICE) Guidelines for Displaced Intracapsular Hip Fractures: Examining Satisfaction with the Guidelines and Effects on Outcomes.

INTRODUCTION: The objectives of the study were to: 1) evaluate satisfaction with the new 2023 National Institute of Health and Care Excellence (NICE) criteria for selecting total hip arthroplasty (THA) over hemiarthroplasty (HA) and surgical recommendations for treatment of displaced intra-capsular hip fractures; 2) describe why THA is performed when NICE criteria are not met; and 3) determine whether satisfaction with these guidelines is associated with improved outcomes. METHODS: A retrospective chart review of patients who had a displaced intra-capsular hip fracture treated with THA at a single tertiary academic center between 2010 and 2022 was performed. Pre-operative patient characteristics were reviewed to determine if the indication for THA met NICE criteria. Operative details, peri-operative complications, re-operation, and revision arthroplasty within 12 months of surgery were recorded. RESULTS: Data from 196 patients (63% women; age 67 ± 10 years) were used. There were 161 THAs (82.1%) that satisfied NICE criteria. The two most common reasons for performing a THA when NICE criteria were not met (n = 35) included pre-operative radiographic osteoarthritis (Tönnis grade ≥ 2; 48.6%) and decreased patient age (< 65 years; 31.5%). Satisfaction with the NICE criteria was associated with fewer peri-operative complications (0.6 versus 37.1%; P < 0.001), re-operations (0.6 versus 31.4%; P < 0.001), and revisions (0.6 versus 28.6%; P < 0.001). The most common reason for revision was periprosthetic fracture, possibly secondary to the use of uncemented femoral stems (171 of 196, 87.2%). DISCUSSION: Satisfaction with the new NICE criteria is associated with improved perioperative outcomes. Further studies are necessary to determine if pre-existing hip osteoarthritis and younger age merit consideration in patient selection.

First deployment of artificial intelligence recommendations in orthopedic surgery.

Scant research has delved into the non-clinical facets of artificial intelligence (AI), concentrating on leveraging data to enhance the efficiency of healthcare systems and operating rooms. Notably, there is a gap in the literature regarding the implementation and outcomes of AI solutions. The absence of published results demonstrating the practical application and effectiveness of AI in domains beyond clinical settings, particularly in the field of surgery, served as the impetus for our undertaking in this area. Within the realm of non-clinical strategies aimed at enhancing operating room efficiency, we characterize OR efficiency as the capacity to successfully perform four uncomplicated arthroplasty surgeries within an 8-h timeframe. This Community Case Study addresses this gap by presenting the results of incorporating AI recommendations at our clinical institute on 228 patient arthroplasty surgeries. The implementation of a prescriptive analytics system (PAS), utilizing supervised machine learning techniques, led to a significant improvement in the overall efficiency of the operating room, increasing it from 39 to 93%. This noteworthy achievement highlights the impact of AI in optimizing surgery workflows.

Impact of Anesthetic Choice on Time to Discharge for Same-Day Discharge Joints.

BACKGROUND: As total joint arthroplasty programs continue to move towards same-day discharge (SDD), time to discharge is an increasingly important performance indicator. The primary objective of this study was to determine the impact of the choice of anesthetic on the time to discharge after SDD primary hip and knee arthroplasty. METHODS: A retrospective chart review was conducted within our SDD arthroplasty program, with 261 patients identified for analysis. Baseline characteristics, length of surgery, anesthetic drug, dose, and perioperative complications were extracted and recorded. The time from the patient leaving the operating room to physiotherapy assessment and from the operating room to discharge were recorded. These were referred to as ambulation time and discharge time, respectively. RESULTS: The ambulation time was significantly reduced when hypobaric lidocaine was used in a spinal block compared to isobaric or hyperbaric bupivacaine-135 minutes (range, 39 to 286), 305 minutes (range, 46 to 591), and 227 minutes (range, 77 to 387), respectively-(P < .0001). Similarly, the discharge time was also significantly lower with hypobaric lidocaine compared to isobaric bupivacaine, hyperbaric bupivacaine, and general anesthesia-276 minutes (range, 179 to 461), 426 minutes (range, 267 to 623), 375 minutes (range, 221 to 511), and 371 minutes (range, 217 to 570), respectively-(P < .0001). No cases of transient neurologic symptoms were reported. CONCLUSION: Patients receiving a hypobaric lidocaine spinal block experienced significantly reduced ambulation time and time to discharge compared to other anesthetics. Surgical teams should feel confident in using hypobaric lidocaine during spinal anesthesia as it is rapid and efficacious.