Movement Is Life—Optimizing Patient Access to Total Joint Arthroplasty: Cardiovascular Health Disparities

Wiznia, Daniel H.; Santos, Elza Maria Carneiro Mendes Ferreira dos; Morgan, Randall C.

doi:10.5435/jaaos-d-21-00920

Cited by 6 publications

(7 citation statements)

References 42 publications

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“…Patients with CVD will likely have questions related to medication regimens and uncertainty about how they should adjust these regimens prior to TJA. Current guidelines that nurse navigators should be familiar with and be prepared to discuss with PCPs and cardiologists include that hypertension medications such as β-blockers, angiotensin II receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors can be continued perioperatively, as can statins or aspirin taken for cardiac protection (American College of Surgeons, 2017; Fleisher et al, 2014; Wiznia, Santos, et al, 2022). In addition, continuation of anticoagulants and nonsteroidal anti-inflammatory agents in the 2 weeks prior to TJA should be discussed with the patient's PCP or cardiologist (American College of Surgeons, 2017; Fleisher et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

Kebeh,

Dlott,

Kurek

et al. 2024

Orthopaedic Nursing

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Diabetes and cardiovascular disease are some of the most common risk factors for complications after total joint arthroplasty (TJA). Preoperative optimization programs are dependent on nurse navigators for coordination of interventions that improve patients' health and surgical outcomes. This article uses information regarding the current practices for diabetes and cardiovascular disease management to provide recommendations for nurse navigators when managing these risk factors prior to TJA. We consulted nurse navigators and conducted a literature review to learn about strategies for addressing diabetes and cardiovascular disease in preoperative optimization programs. Nurse navigators can play a critical role in addressing these conditions by providing patient education and implementing preoperative optimization protocols that incorporate discussion regarding guidelines for diabetes and cardiovascular disease management prior to surgery. This article shares recommendations and resources for nurse navigators to help address diabetes and cardiovascular disease as part of preoperative optimization programs.

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Section: Discussionmentioning

confidence: 99%

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

Kebeh,

Dlott,

Kurek

et al. 2024

Orthopaedic Nursing

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“…26 They may require additional care both before and after their surgery to ensure a successful outcome, such as more extensive preoperative medical optimization, a longer hospital stay, or a discharge to a skilled nursing facility. 6,[27][28][29][30] This increased comorbidity burden among some minorities is likely a notable contributor to racial disparities in postoperative complication rate-a 2021 study found that race was not an independent risk factor of 30-day complications for total knee arthroplasty after controlling for comorbidities. 31 The gaps in applicability of the JC process measure to the needs of more socially vulnerable populations with greater comorbidity burden may explain the discrepancy in our findings between the CMS and JC analyses.…”

Section: Discussionmentioning

confidence: 99%

“…35 Similarly, process measures could be adjusted or introduced to evaluate preoperative patient optimization with a specific focus on social determinants of health, such as food access, health literacy, and utilization of social safety net and community resources. 29,30 Additional studies are needed to assess the viability of these proposed policy solutions.…”

Section: Discussionmentioning

confidence: 99%

Healthcare Market-Level and Hospital-Level Disparities in Access to and Utilization of High-Quality Hip and Knee Replacement Hospitals Among Medicare Beneficiaries

Oddleifson

Wiznia

et al. 2023

J Am Acad Orthop Surg

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Introduction: This study aimed to determine whether healthcare markets with higher social vulnerability have lower access to high-quality hip and knee replacement hospitals and whether hospitals that serve a higher percentage of low-income patients are less likely to be designated as high-quality. Methods: This cross-sectional study used 2021 Centers for Medicare and Medicaid Services outcome measures and 2022 Joint Commission (JC) process-of-care measures to identify hospitals performing high-quality hip and knee replacement. A total of 2,682 hospitals and 304 healthcare markets were included. For the market-level analysis, we assessed the association of social vulnerability with the presence of a high-quality hip and knee replacement center. For the hospital-level analysis, we assessed the association of disproportionate share hospital (DSH) percentage with each high-quality designation. Healthcare markets were approximated by hospital referral regions. All associations were assessed with fractional regressions using generalized linear models with binomial family and logit links. Results: We found that healthcare markets in the most vulnerable quartile were less likely to have a hip and knee replacement hospital that did better than the national average (odds ratio [OR] 0.22, P = 0.02) but not more or less likely to have a hospital certified as advanced by JC (OR 0.41, P = 0.16). We found that hip and knee replacement hospitals in the highest DSH quartile were less likely to be designated by the Centers for Medicare and Medicaid Services as better than the national average (OR 0.18, P = 0.001) but not more or less likely to be certified as advanced by JC (OR 1.40, P = 0.28). Discussion: Geographic distribution of high-quality hospitals may contribute to socioeconomic disparities in patients' access to and utilization of high-quality hip and knee replacement. Equal access to and utilization of hospitals with high-quality surgical processes does not necessarily indicate equitable access to and utilization of hospitals with high-quality outcomes. Level of evidence: Level III.

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“…In other studies, CRP was directly related to periprosthetic infections in orthopedic patients and was found to be the most specific marker (87.10%). [24][25][26] Nevertheless, other parallel causes for an elevated CRP value, especially in elderly patients, should be excluded during hospitalization. Among the pre-diseases described above, arterial hypertension, renal insufficiency, aspirin intake and COPD were shown to be associated with the occurrence of systemic complications.…”

Section: Discussionmentioning

confidence: 99%

“…Further studies underlined an increased risk of complications in connection with cardiovascular and renal pre-diseases of the patients. 24,25 Therefore, in preoperative planning, increased attention should be paid to a well-controlled arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Analysis of Perioperative Complications in Octogenarians and Patients under 60 Years of Age after Primary Cemented Total Knee Arthroplasty

Koettnitz,

Isbeih,

Peterlein

et al. 2023

Clin Med Res

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Introduction: Knee arthroplasty is exposed to demographic changes as patients age. An analysis of risk factors for surgical treatment decisions in patients over 80 years old is crucial. This study compared perioperative complications between groups of patients undergoing primary knee arthroplasty, under 60 years old and over 80 years old. Materials and Methods:For this retrospective study, data from 400 patients with primary cemented bi-and unicondylar total knee endoprosthesis during inpatient stay from 2017 to 2018 were analyzed. Patients aged 61-79 years (257) were excluded. An analysis of the remaining 143 patients was performed. The incidence of surgery-related and systemic complications (eg, urinary tract infections, electrolyte imbalances, and cases of pneumonia), the blood supply and C-reactive protein (CRP) as well as hemoglobin progression were compared across both age groups. Furthermore, a correlation between prevalent diseases and systemic complications were investigated. Statistical analysis was performed using IBM SPSS (Armonk, US).Results: Data analyses showed a significant difference in the occurrence of systemic complications and blood transfusion between the age groups (P = 0.001, phi = 0.44; phi= 0.55, P = 0.001). Surgical complications did not differ significantly between the age groups. Age-typical pre-existing conditions, especially arterial hypertension (P = 0.003), showed a significant association with the occurrence of systemic complications. In addition, high postoperative CRP values in elderly patients revealed an association to systemic complications (P = 0.008). Discussion and Conclusion:The study shows that primary cemented knee arthroplasty is a safe procedure without an increased incidence of surgical complications, even in elderly patients. The increased incidence of internal complications in octogenarians, in turn, should receive more attention in the perioperative course. The interdisciplinary preoperative optimization of pre-existing conditions and drug therapy, as well as close interdisciplinary assessments of elderly patients, should be ensured.

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Movement Is Life—Optimizing Patient Access to Total Joint Arthroplasty: Cardiovascular Health Disparities

Cited by 6 publications

References 42 publications

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

Orthopaedic Nurse Navigators and Total Joint Arthroplasty Preoperative Optimization

Healthcare Market-Level and Hospital-Level Disparities in Access to and Utilization of High-Quality Hip and Knee Replacement Hospitals Among Medicare Beneficiaries

A Comparative Analysis of Perioperative Complications in Octogenarians and Patients under 60 Years of Age after Primary Cemented Total Knee Arthroplasty

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