Preoperative Risk Stratification and Risk Reduction for Total Joint Reconstruction

Ng, Vincent Y.; Lustenberger, David P; Hoang, Kimberly; Urchek, Ryan; Beal, Matthew D.; Calhoun, Jason H.; Glassman, Andrew H.

doi:10.2106/jbjs.l.00603

Cited by 45 publications

(22 citation statements)

References 12 publications

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“…The PAC and anesthesiologist need to be aware of the indicated investigations so that reasonable requests will be made and resources will not become saturated. Conditions requiring mandatory investigation are summarized in “ Cardiac Conditions Requiring Mandatory Investigation ” [23]. …”

Section: Discussionmentioning

confidence: 99%

Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

Dalton

Kelly

Murphy

et al. 2016

Advances in Orthopedics

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Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.

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Section: Discussionmentioning

confidence: 99%

Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

Dalton

Kelly

Murphy

et al. 2016

Advances in Orthopedics

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“…Yoon et al demonstrated that patients who attended a pre-operative education class had a significantly shorter LOS than patients who did not [16]. Studies by Ng et al and Duplantier et al have demonstrated improved outcomes and decreased LOS when patients are medically optimized in a standardized fashion prior to surgery [17,18]. Boraiah et al and Iorio have discussed risk stratification and stressed optimization prior to joint replacement surgery, with special attention placed on modifiable risk factors.…”

Section: Pre-operative Phasementioning

confidence: 99%

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

Chimento

Thomas

2017

Curr Rev Musculoskelet Med

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Purpose of Review The perioperative surgical home (PSH) is a patient-centered, physician-led, multidisciplinary care pathway developed to deliver value-based care based on shared decision-making. Physician and hospital reimbursement will be tied to providing quality care at lower cost, and the PSH model has been used in providing care to patients undergoing lower extremity arthroplasty. The purpose of this review is to discuss the rationale, definition, development, current state, and future direction of the PSH. Recent Findings The PSH model guides the patient throughout the pre and perioperative process and into the postoperative phase. It has been shown in multiple studies to decrease length of stay, improve functional outcomes, allow more home discharges, and lower costs. There is no increase in complications or readmission rates. Summary The PSH pathway is a safe and effective method of providing value-based care to patients undergoing hip and knee arthroplasty.

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“…Zahlreiche Publikationen belegen eine erhöhte Mortalität und Morbidität sowie eine erhöhte Rate an periprothetischen Infektionen bei Vorliegen eines metabolischen Syndroms bzw. eines Diabetes mellitus [12][13][14]. Hinsichtlich der isolierten Bedeutung eines erhöhten HbA1c-Wertes sind die Angaben der Literatur noch widersprüchlich [15].…”

Section: Optimierung Der Stoffwechsellageunclassified

Was ist ein Muss in der präoperativen Diagnostik vor elektiver Endoprothetik?

Haas

Weber

2017

Z Orthop Unfall

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A thorough pre-operative evaluation is required prior to total joint arthroplasty (TJA). The objective of screening is to identify patient- and procedure-related risk constellations. Pre-operative diagnostic measures are vital in order to anticipate, reduce or even eliminate threats to patient safety. Furthermore, the clinical and radiographical workup may confirm the indication and type of surgical procedure, but this is not the subject of this article. An overview of the current literature on pre-operative diagnostic principles is presented. A selective literature analysis was performed. We identified recommendations related to the following: (1) preoperative anaemia, (2) metabolic optimisation, (3) weight control, (4) obstructive sleep apnoea, (5) MRSA and skin decontamination, (6) urinary tract infections (UTI), (7) dental screening (8) cardiological workup, (9) technical considerations on primary and revision arthroplasty. While clear evidence-based recommendations for every item are not yet available, a critical pre-operative evaluation including history taking, physical exam, laboratory tests and imaging studies remains essential. The ongoing evolution of improved perioperative care and implications for patient safety will further increase the scope of necessary preoperative diagnostic measures.

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Preoperative Risk Stratification and Risk Reduction for Total Joint Reconstruction

Cited by 45 publications

References 12 publications

Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

The Perioperative Surgical Home: Improving the Value and Quality of Care in Total Joint Replacement

Was ist ein Muss in der präoperativen Diagnostik vor elektiver Endoprothetik?

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