Outpatient Total Hip Arthroplasty

Dorr, Lawrence D.; Thomas, Deborah J; Zhu, Jinjun; Dastane, Manish; Chao, Lisa; Long, William T.

doi:10.1016/j.arth.2009.06.005

Cited by 182 publications

(134 citation statements)

References 31 publications

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“…Prior work that has examined outpatient discharge protocols after THA is in highly selected patient groups without control subjects [5,8]. Also, many studies have used the term ''outpatient'' loosely and often refer to the ''23-hour stay'' patient as an ''outpatient,'' although the patient stayed overnight in the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the difference may reflect an increased amount of pain when patients go home and have potentially increased activity as compared with an overnight stay in a hospital bed. Several investigators [1][2][3][4][5]8] have written about pathways for the success of early-discharge THA and TKA and more recently [5,8] have published on prospective evaluations of patients undergoing outpatient THA. Adult reconstructive surgeons nationally have adopted clinical pathways similar to those published by this group for inpatient THA as an evolution of the management of these patients undergoing elective surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, when comparing a same-day discharge with a discharge after an overnight stay, there is in actuality not a large difference in the number of hours of hospitalization, and so it may not be surprising that there was no discernible difference in complications. Three prior studies [2,5,8] have affirmed the safety of outpatient THA; however, all of these studies were among nonrandomized, highly selected patient populations with no control group.…”

Section: Discussionmentioning

confidence: 99%

“…With the goal of decreasing LOS, modern surgical techniques, advances in regional anesthesia, improved postoperative pain management with multimodal and preemptive analgesia, and rapid rehabilitation protocols have allowed patients undergoing THA to be discharged from the hospital as early as the day of surgery with high patient satisfaction and infrequent complications in appropriately selected patients [1,5,6,8]. However, the published studies that have examined same-day and ''early'' discharge protocols after THA are in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects [5,8].…”

Section: Introductionmentioning

confidence: 99%

“…However, the published studies that have examined same-day and ''early'' discharge protocols after THA are in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects [5,8].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Goyal

Chen

Padgett

et al. 2017

Clinical Orthopaedics &Amp; Related Research

223

203

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Background Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.Questions/purposes The purpose of this study was to evaluate and compare patients undergoing THA who are discharged on the same day as the surgery (''outpatient,'' less than 12-hour stay) with those who are discharged after an overnight hospital stay (''inpatient'') with regard to the following outcomes: (1) postoperative pain; (2) perioperative complications and healthcare provider visits (readmission, One of the authors (AFC) has received research support funding from 3M (Maplewood, MN, USA) and Myoscience (Fremont, CA, USA). One of the authors (WGH) has received research support funding from DePuy (DePuySynthes, New Brunswick, NJ, USA), Biomet (Warsaw, IN, USA), and Nimbic Systems (Stafford, TX, USA). The institution of one or more of the authors (NG, SEP, RHH, WGH) has received, during the study period, funding from the Inova Health System (Falls Church, VA, USA). One of the authors (NG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Cayenne Medical (Scottsdale, AZ, USA) and Stryker Orthopedics (Mahwah, NJ, USA). One of the authors (AFC), or a member of her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from ACI Clinical (Bala Cynwyd, PA, USA). One of the authors (WGH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from DePuy, Biomet, and Nimbic Systems. One of the authors (WJH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker. One of the authors (NG) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: Data Trace Publishing Company (Towson, MD, USA) in the amount of USD 10,000 to USD 100,000. One of the authors (AFC) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: SLACK Incorporated (Thorofare, NJ, USA) in the amount of less than USD 10,000. (3) relative work effort for the surgeon's office staff. Methods A prospective, randomized study was conducted at two high-volume adult reconstruction centers between July 2014 and September 2015. Patients who were younger than 75 years of age at surgery, who could ambulate without a walker, who were n...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Goyal

Chen

Padgett

et al. 2017

Clinical Orthopaedics &Amp; Related Research

223

203

View full text Add to dashboard Cite

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The Next Generation of Episode-Based Payments

Navathe

Song

Emanuel

2017

JAMA

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and Human Services (DHHS) announced the final models forthenextgroupofmandatoryepisode-basedpayments. All hospitals accepting Medicare patients in 98 metropolitan areas will be required to accept bundled payments, which include a fixed payment for hospital care plus services for the 90 days following discharge of patients with acute myocardial infarction and coronary artery bypass graft surgery. 1 Even though the future of bundled payments remains uncertain, as illustrated by the recent de-layinDHHSimplementationofmandatorycardiacbundles until October 2017, episode-based payments are a fundamentalcomponentofalternatepaymentmodelscurrently being instituted by Medicare and private payers.Bundled payments offer advantages over feefor-service and global budget models. First, bundled payments focus on a smaller group of services that tend to belong together clinically, potentially making care redesign for bundles easier for health systems to implement than global budget-based accountable care organizations (ACOs). Preliminary evidence from bundled payment programs suggests that bundles are associated with similar or better quality for patients, reductions in Medicare payments, higher profits for hospitals, and higher physician compensation. 2,3 Second, bundled payment models could be combined such that organizations can participate in several individual, clinically distinct bundles simultaneously. This allows organizations a stepwise transition into financial risk across distinct segments of care before committing to global risk across the continuum of care. Consequently, bundled payments can be made mandatory for hospitals and physician practices, whereas global budget ACOs would be difficult to mandate for smaller practices that lack the infrastructure or human resources to manage population health. In addition, bundled payments may better engage specialists, surgeons, and primary care physicians (PCPs) in practice transformation.Current bundled payment models have limitations. They retain the fee-for-service incentive to do more, especially for conditions without well-defined criteria for intervention, and to select healthier patients, potentially increasing low-value care use that offsets efficiency savings. 4 Bundled payments must be restricted to conditions with a clear starting point and those in which there is only limited physician and patient discretion.The next generation of bundled payments should align with population health by (1) extending the duration of the bundles, (2) expanding the accountable entities beyond hospitals, and (3) integrating bundled payments with global budget models within ACOs. Extending Bundle Duration-The 1-Year Bundle?A central challenge of current bundles is their short duration because most cover services up to 90 days after

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The Changing World of Total Joint Arthroplasty

Scuderi

2020

Rapid Recovery in Total Joint Arthroplasty

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Outpatient Total Hip Arthroplasty

Cited by 182 publications

References 31 publications

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

The Next Generation of Episode-Based Payments

The Changing World of Total Joint Arthroplasty

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