Effects of an anesthesia perioperative surgical home for total knee and hip arthroplasty at a Veterans Affairs Hospital: a quality improvement before-and-after cohort study

Alvis, Bret; Amsler, Roland G.; Leisy, Philip J; Feng, Xiaoke; Shotwell, Matthew S.; Pandharipande, Pratik; Ajmal, Muhammad; McHugh, Michael; Walia, Ann; Hughes, Christopher

doi:10.1007/s12630-020-01865-4

Cited by 7 publications

(13 citation statements)

References 17 publications

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“…Paradoxically, in their analysis 90 days after hip and knee arthroplasty, Jørgensen et al found that fall-related hospital readmissions were due to physical activity and extrinsic factors other than surgery because of patient success and intent to return to a normal level of activity [ 24 ]. As emerged from all of the studies examined in this review, in turn, all of these interventions reduce the LOS as patients could be discharged sooner without increasing the risk of complications (References [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , …”

Section: Resultsmentioning

confidence: 99%

“…Designation of positive, neutral and negative outcome for each examined study. (References [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 ...…”

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confidence: 99%

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Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Salamanna

Contartese

Brogini

et al. 2022

JCM

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Enhanced recovery after surgery (ERAS) protocols have led to improvements in outcomes in several surgical fields, through multimodal optimization of patient pathways, reductions in complications, improved patient experiences and reductions in the length of stay. However, their use has not been uniformly recognized in all orthopedic fields, and there is still no consensus on the best implementation process. Here, we evaluated pre-, peri-, and post-operative key elements and clinical evidence of ERAS protocols, measurements, and associated outcomes in patients undergoing different orthopedic surgical procedures. A systematic literature search on PubMed, Scopus, and Web of Science Core Collection databases was conducted to identify clinical studies, from 2012 to 2022. Out of the 1154 studies retrieved, 174 (25 on spine surgery, 4 on thorax surgery, 2 on elbow surgery and 143 on hip and/or knee surgery) were considered eligible for this review. Results showed that ERAS protocols improve the recovery from orthopedic surgery, decreasing the length of hospital stays (LOS) and the readmission rates. Comparative studies between ERAS and non-ERAS protocols also showed improvement in patient pain scores, satisfaction, and range of motion. Although ERAS protocols in orthopedic surgery are safe and effective, future studies focusing on specific ERAS elements, in particular for elbow, thorax and spine, are mandatory to optimize the protocols.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Salamanna

Contartese

Brogini

et al. 2022

JCM

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“…The study limitations include not having all the important factors for the analysis like patient's age, gender, Body Mass Index (BMI), and ASA score. Past studies have found these confounders were associated with the orthopedic surgical outcomes including LOS, discharge disposition, and 90-days readmission (Alvis et al, 2021;Duplantier et al, 2015;Garson et al, 2014;Kim et al, 2017;Kim et al, 2019;Powell et al, 2017;Qiu et al, 2016). Second, the study was only able to compare a five-month duration (November to April) for both cohorts.…”

Section: Discussionmentioning

confidence: 95%

A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Sridhar

Carnegie

Mouat-Hunter

et al. 2022

Proceedings of the International Symposium on Human Factors and

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Background: The Perioperative Surgical Home (PSH) was designed by the American Society of Anesthesiologists (ASA) to improve perioperative care through more coordinated and communicative decision-making. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. Thus, this study compared surgical outcomes – LOS, discharge disposition, and 90-day readmission – at a rural hospital from cohorts before and after the implementation of PSH. Method: An initial model of a PSH system was initiated in a local rural hospital. This newly created clinical team and outpatient clinic retrospectively assessed total joint surgeries occurring from November 2017 to April 2018 (before PSH, n = 324) as well as from November 2018 to April 2019 (after PSH, n = 326). General linear models were used to understand the impact of PSH on rural surgical outcomes. Results: Implementing PSH had a positive impact on LOS (P-value < 0.01), discharge disposition (P-value < 0.01), and readmission (P-value = 0.03).Conclusion: Implementation of the PSH system in a rural, community hospital reduced LOS, 90-day readmission, and increased direct to home discharge. Increased clinical management standardization across internal and external stakeholders was achieved because the PSH clinic enabled a centralized navigation point for clinicians, patients, and their families to better communicate and coordinate care.

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“…In both evaluations, the LOS was shorter in the PSH cohort compared to the control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h)[ 14 , 33 , 34 ]. Although there was no statistical difference in LOS between the PSH and the C2-PSH cohort in the unadjusted analysis, the LOS was significantly shorter in the PSH cohort (10% shorter) in the adjusted analysis.…”

Section: Discussionmentioning

confidence: 99%

“…The baseline characteristics were compared with variables including patient age, gender, body mass index (BMI), ASA score (Class 1, 2, 3, or 4), procedure type (THA, TKA, and TSA) and insurance type (private or public payer). These variables were included in the baseline characteristics and in the analysis, as they were found to be potential confounders at PSH implemented hospitals with the surgical outcomes LOS, discharge disposition, and 90-d readmission[ 14 , 16 , 24 , 33 , 34 ].…”

Section: Methodsmentioning

confidence: 99%

Rural implementation of the perioperative surgical home: A case-control study

Sridhar¹,

Mouat-Hunter²,

McCrory³

2023

World J Orthop

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BACKGROUND Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas. AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study. METHODS The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts ( n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) ( n = 1413) and Control-2 PSH (C2-PSH) ( n = 892)]. Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t -test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models. RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) ( P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) ( P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital. CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.

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Effects of an anesthesia perioperative surgical home for total knee and hip arthroplasty at a Veterans Affairs Hospital: a quality improvement before-and-after cohort study

Cited by 7 publications

References 17 publications

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

Key Components, Current Practice and Clinical Outcomes of ERAS Programs in Patients Undergoing Orthopedic Surgery: A Systematic Review

A Rural Community Hospital’s Perioperative Surgical Home Model Compared to a Traditional Surgical System

Rural implementation of the perioperative surgical home: A case-control study

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