Enhanced Preoperative Education Pathways: A Step Toward Reducing Disparities in Total Joint Arthroplasty Outcomes

Turcotte, Justin; Brennan, Jane C; Holbert, S. Elliott; Dolle, Steffanie S.; King, Paul J.

doi:10.1016/j.arth.2022.03.029

Cited by 15 publications

(14 citation statements)

References 35 publications

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“…Furthermore, in 2019, an enhanced preoperative education pathway was launched which provided individualized counseling and education to minority patients and those with multiple comorbidities or socioeconomic risk factors. Evaluation of the first year of the program revealed that patients treated through an enhanced preoperative education pathway experienced similar lengths of stay, rates of home discharge, and 30-day readmissions to lower-risk patients not utilizing the pathway and that outcomes were similar between AA and non-AA patients [ 18 ]. Similar to our own results, Aseltine et al.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

Holbert¹,

Brennan²,

Johnson³

et al. 2023

Arthroplasty Today

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

Holbert¹,

Brennan²,

Johnson³

et al. 2023

Arthroplasty Today

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“…However, given that risk scores are often developed using large surgical databases, it is important to consider whether studies have been conducted specifically investigating the validity of these scores for TJA patients (Trickey et al, 2020). A study by Turcotte et al (2022) evaluated the use of a preoperative education pathway on patient outcomes following TJA. Patients who participated in the education pathway had more medical comorbidities, yet were able to achieve similar outcomes to the broader patient population (Turcotte et al, 2022).…”

Section: Discussionmentioning

confidence: 99%

“…A study by Turcotte et al (2022) evaluated the use of a preoperative education pathway on patient outcomes following TJA. Patients who participated in the education pathway had more medical comorbidities, yet were able to achieve similar outcomes to the broader patient population (Turcotte et al, 2022). If surgeons are able to identify patients who may benefit from additional resources using validated risk scores, this may facilitate more equitable patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Use of Risk Scores in Patient Preoperative Optimization for Total Joint Arthroplasty

Dlott

Wilkins

Miguez

et al. 2023

Orthopaedic Nursing

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Preoperative optimization of patients seeking total joint arthroplasty is becoming more common, and risk scores, which provide an estimate for the risk of complications following procedures, are often used to assist with the preoperative decision-making process. The aim of this study was to characterize the use of risk scores at institutions that utilize nurse navigators in the preoperative optimization process. The survey included 207 nurse navigators identified via the National Association of Orthopaedic Nurses to better understand the use of risk scores in preoperative optimization and the different factors that are included in these risk scores. The study found that 48% of responding nurse navigators utilized risk scores in the preoperative optimization process. These risk scores often included patient comorbidities such as diabetes (85%) and body mass index (87%). Risk scores are commonly used by nurse navigators in preoperative optimization and involve a variety of comorbidities and patient-specific factors.

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“…Pandya et al [11] recommended the use of a 10-item checklist of actions that can be used by individual surgeons to aid in the lessening of care disparities in their practice. Turcotte et al [18] evaluated the effect of an enhanced preoperative education pathway (EPrEP) on outcomes after TJA and found that although no differences in LOS or discharge disposition occurred based on race, use of an EPrEP resulted in a 51% reduction in 30-day postoperative emergency room visits. Unfortunately, despite increasing evidence highlighting persistent disparities in orthopedic care, few studies have investigated the efficacy of interventions used to reduce such disparities.…”

Section: Discussionmentioning

confidence: 99%

Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study

Kunze

Estrada

Apostolakos

et al. 2022

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Limited English language proficiency in patients undergoing total shoulder arthroplasty (TSA) may make treatment more challenging. Purpose: We sought to investigate the potential association between TSA patients’ use of a language interpreter and 2 outcomes: hospital length of stay (LOS) and discharge disposition. Methods: We conducted a retrospective cohort study comparing LOS and discharge disposition after TSA for patients who required interpreter services and patients who did not at a single institution in an urban setting between 2016 and 2020. Consecutive patients requiring interpreter services who underwent TSA were matched 1:1 to patients who did not require an interpreter by age, body mass index (BMI), sex, and procedure. Multivariate regression models controlling for age, BMI, sex, smoking, opioid use, white or non-white race, procedure, and diagnosis were constructed to determine associations between interpreter use, LOS, and discharge disposition. Results: Forty-one patients were included in each cohort, exceeding the minimum number required per an a priori power analysis. Mean hospital LOS was longer in the interpreter cohort than in the non-interpreter cohort (2.8 ± 2.4 vs 1.8 ± 1.0 days, respectively). Multivariate linear regression demonstrated interpreter use was the strongest predictor of LOS, with the effect estimate indicating an additional 0.88-day LOS per patient. A greater proportion of patients from the interpreter cohort were discharged to an acute/subacute rehabilitation facility than patients from the non-interpreter cohort ( n = 8 [19.5%] vs n = 2 [4.9%], respectively). Patients from the interpreter cohort were 454% more likely to be discharged to acute/subacute rehabilitation facilities. Conclusions: Our retrospective analysis of patients undergoing TSA suggests that the need for interpreter services may be associated with increased LOS and discharge to a facility. More rigorous study is needed to identify the factors that influence these outcomes and to avoid disparities in hospital stay and discharge.

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Enhanced Preoperative Education Pathways: A Step Toward Reducing Disparities in Total Joint Arthroplasty Outcomes

Cited by 15 publications

References 35 publications

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

Racial Disparities in Outcomes of Total Joint Arthroplasty at a Single Institution: Have We Made Progress?

The Use of Risk Scores in Patient Preoperative Optimization for Total Joint Arthroplasty

Association Between Limited English Language Proficiency and Disparities in Length of Stay and Discharge Disposition After Total Shoulder Arthroplasty: A Retrospective Cohort Study

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