Primary Hip and Knee Arthroplasty in a Safety Net Hospital: Substance Abuse and Other Factors Affecting Short-term Complications

Jergesen, Harry E.; Thielen, Zachary; Roever, Jay A.; Vashon, Toure T.; Wu, Hao; Yi, Paul H.

doi:10.1016/j.arth.2018.05.007

Cited by 12 publications

(8 citation statements)

References 40 publications

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“…This was found to correlate highly with post-operative complications at this institution and so a previously published "sobriety pathway" was developed and has been in place for two decades. [27] This requires patients to have a documented period of sobriety for 12 months prior to J o u r n a l P r e -p r o o f proceeding with arthroplasty. This obviously intentionally elongates surgical wait times in this population at this hospital and they were thus excluded from analysis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

Soriano

Toogood

2022

Arthroplasty Today

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Background Although insurance status is important to patients’ ability to access care, it varies significantly by race, age, and socioeconomic status. COVID-19 negatively impacted access to care, while simultaneously widening pre-existing health care disparities. The purpose of the current study was to document this phenomena within orthopedics. Methods Patients undergoing hip or knee arthroplasty at two medical centers in San Francisco, California were evaluated. One cohort came from the University of California San Francisco (UCSF), a tertiary center and the other from Zuckerberg San Francisco General Hospital (ZSFGH), a safety-net hospital. Patients undergoing arthroplasty prior to the pandemic (March 2020) and after pandemic declaration were evaluated. Patient demographics, surgical wait times, and operative volumes were compared. Results 269 (pre-COVID, 184; post-COVID, 85) cases at UCSF and 63 (pre-COVID, 47; post-COVID, 16) cases at ZSFGH met inclusion criteria. Patients at ZSFGH had a significantly higher BMI, were more often racial minorities, and were less likely to speak English. Patients at ZSFGH were less likely to have private insurance. Comparing case volumes showed a larger decrease at ZSFGH compared to UCSF post-COVID. Wait times between the two sites pre- and post-COVID showed a larger increase in wait times at ZSFGH. Notably, wait times at ZSFGH pre-COVID were more than double the wait times at UCSF post-COVID. Conclusions COVID-19 worsened access to primary hip and knee arthroplasty at two academic medical centers in San Francisco. The pandemic also worsened pre-existing disparities. Racial minorities, non-English speakers, and those with non-private insurance were affected most.

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Section: Discussionmentioning

confidence: 99%

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

Soriano

Toogood

2022

Arthroplasty Today

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“…In order to perform the meta-analysis, we identified 14 studies ( 6 , 7 , 8 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ) that met our inclusion criteria (see Table 1 ). All were retrospective cohort studies.…”

Section: Methodsmentioning

confidence: 99%

A meta-analysis of postoperative outcomes of patients with and without chronic hepatitis C undergoing primary total hip or knee arthroplasty

et al. 2023

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Purpose This investigation provides a rigorous systematic review of the postoperative outcomes of patients with and without chronic hepatitis C who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods We queried PubMed, Embase, Cochrane Database of Systematic Reviews, Scopus, Web of Science and the ‘gray’ literature, including supplemental materials, conference abstracts and proceedings as well as commentary published in various peer-reviewed journals from 1992 to present to evaluate studies that compared the postoperative outcomes of patients with and without chronic hepatitis C who underwent primary THA or TKA. This investigation was registered in the PROSPERO international prospective register of systematic reviews and follows the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In our literature search, we identified 14 articles that met our inclusion criteria and were included in our fixed-effects meta-analysis. The postoperative outcomes analyzed included periprosthetic joint infection (PJI), aseptic revision, non-homebound discharge and inpatient mortality. Results Our statistical analysis demonstrated a statistically significant increase in postoperative complications of patients with chronic hepatitis C who underwent primary THA or TKA including PJI (odds ratio (OR): 1.98, 95% CI: 1.86 – 2.10), aseptic revision (OR: 1.58, 95% CI: 1.50 – 1.67), non-homebound discharge (OR: 1.31, 95% CI: 1.28– 1.34) and inpatient mortality (OR: 9.37, 95% CI: 8.17 – 10.75). Conclusion This meta-analysis demonstrated a statistically significant increase in adverse postoperative complications in patients with chronic hepatitis C who underwent primary THA or TKA compared to patients without chronic hepatitis C.

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“…Illicit substance abuse is also commonly seen in orthopaedic patients and is associated with poor postoperative outcomes 63,64 . Especially in patients with intravenous drug use, where severe complications are relatively common, the literature recommends against elective surgery if possible 64,65 .…”

Section: Addictionmentioning

confidence: 99%

The “Top 10” Psychosocial Factors Affecting Orthopaedic Outcomes

Curtis

Fine

Moya

et al. 2022

JBJS Journal of Orthopaedics for Physician Assistants

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Introduction:Many patients within the orthopaedic population experience 1 or more psychosocial issues that may profoundly affect their postoperative outcomes after orthopaedic surgery. Despite the common nature of these factors, there is a paucity of literature describing their effect on orthopaedic outcomes. The purpose of this review was to describe the anecdotal 10 most-encountered psychosocial factors in our patient population, their described influence on orthopaedic outcomes, and how they may be addressed. These factors include expectations, fear of reinjury, socioeconomic status, social support, allergies, addiction, depression and anxiety, resilience, self-efficacy, and other mental health disorders.Methods:A thorough review of the PubMed-indexed literature was conducted using each one of our psychosocial factors described here combined with the key words “orthopaedic outcome.”Study Design:This was a clinical review paper.Level of Evidence:Not applicable.Results:These 10 psychosocial influences have dramatic effects on the recovery and outcomes after orthopaedic procedures. Patients benefit from early recognition and management of these issues before and after surgery.Conclusions:Each of the psychosocial factors reviewed in this paper has a significant influence on outcomes after orthopaedic surgery. A strong understanding of these factors and how to address them will aid orthopaedic surgeons in maximizing postoperative outcomes for their patients. Further research is necessary to improve our treatment strategies for this complex patient population.

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Primary Hip and Knee Arthroplasty in a Safety Net Hospital: Substance Abuse and Other Factors Affecting Short-term Complications

Cited by 12 publications

References 40 publications

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

Effect of Institution and COVID-19 on Access to Adult Arthroplasty Surgery

A meta-analysis of postoperative outcomes of patients with and without chronic hepatitis C undergoing primary total hip or knee arthroplasty

The “Top 10” Psychosocial Factors Affecting Orthopaedic Outcomes

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