Journal article
Rapid Recovery Total Joint Arthroplasty is Safe, Efficient, and Cost-Effective in the Veterans Administration Setting
The Journal of arthroplasty, Vol.33(10), pp.3138-3142
10/2018
DOI: 10.1016/j.arth.2018.07.004
PMID: 30077468
Abstract
Institutional pathways in total joint arthroplasty (TJA) have been shown to reduce costs and improve patient care, but questions remain regarding their efficacy in certain populations. We sought to evaluate the comprehensive effect of a rapid recovery perioperative TJA protocol in the Veterans Health Administration (VA) setting.
In a VA hospital, a rapid recovery protocol was implemented for all patients undergoing primary total hip or knee arthroplasty. A retrospective chart review was performed comparing pre-protocol (n = 174) and protocol (n = 78) cohorts. Measured outcomes included length of stay (LOS), discharge destination, unplanned readmissions, overall complications, and total cost of healthcare during admission and at 30 and 90 days postoperatively.
After implementation of the protocol, the average LOS decreased from 3.2 to 1.7 days (P < .0001). In the protocol group, there was a 12.3% increase in patients discharging directly home (85.1% vs 97.4%, P = .005). There were lower unplanned readmissions (6.3% vs 3.8%, P = .56) and overall complications (7.5% vs 3.8%, P = .40), but these were not statistically significant. The summative cost of all perioperative healthcare was lower after implementation of the protocol during the inpatient stay ($19,015 vs $21,719, P = .002) and out to 30 days postoperatively ($21,083 vs $23,420, P = .03) and 90 days postoperatively ($24,189 vs $26,514, P = .07).
In the VA setting, implementation of a rapid recovery TJA protocol led to decreased LOS, decreased cost of perioperative healthcare, and an increase in patients discharging directly home without increased readmission or complication rates. Such protocols are essential as we transition into an era of value-based arthroplasty.
Details
- Title: Subtitle
- Rapid Recovery Total Joint Arthroplasty is Safe, Efficient, and Cost-Effective in the Veterans Administration Setting
- Creators
- John M Yanik - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IowaNicholas A Bedard - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IowaJessica M Hanley - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IowaJesse E Otero - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IowaJohn J Callaghan - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IowaJohn L Marsh - Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- The Journal of arthroplasty, Vol.33(10), pp.3138-3142
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.arth.2018.07.004
- PMID
- 30077468
- ISSN
- 0883-5403
- eISSN
- 1532-8406
- Language
- English
- Date published
- 10/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
- Record Identifier
- 9984040263102771
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