The Journal of arthroplasty
-
The purpose of this study was to evaluate the effect of preoperative opioid use on opioid prescriptions, refills, and clinical outcomes after total knee arthroplasty (TKA). ⋯ Preoperative opioid users were discharged with less opioids, required more refills, were more likely to remain on opioids, and required more manipulations under anesthesia than opioid-naive patients. These risks extended to preoperative tramadol users.
-
Observational Study
How Much Pain Is Significant? Defining the Minimal Clinically Important Difference for the Visual Analog Scale for Pain After Total Joint Arthroplasty.
The ability to detect changes in patient-perceived pain after total joint arthroplasty (TJA) is critical to manage postoperative pain. The minimal clinically important difference (MCID) for visual analog scale for pain (VAS-P) has not been investigated in this population. This study investigated the MCID for VAS-P in the TJA population. ⋯ In the postoperative TJA population, VAS-P MCID changes depend on the type of surgical intervention, and whether pain is improving or worsening. Statistically significant VAS-P, improving -18.6 mm and -22.6 mm for THA and TKA patients, respectively, sets a reasonable threshold to identify clinically meaningful pain intervention with high specificity.
-
Limited data describe risks and perioperative resource needs of total joint arthroplasty (TJA) in dialysis-dependent patients. ⋯ Dialysis-dependence is an independent risk factor for 30-day adverse events, ICU care, longer admission, and rehabilitation needs in TJA patients. Thirty days is not sufficient to detect infectious complications among these patients. These findings inform shared decision-making, perioperative resource planning, and risk adjustment under alternative reimbursement models.
-
The purpose of this study was to compare risks for revision and short-term complications after total joint arthroplasty (TJA) in matched cohorts of morbidly obese patients, receiving and not receiving prior bariatric surgery. ⋯ After accounting for relevant selection biases, bariatric surgery prior to TJA was associated with reduced co-morbidity burden at the time of TJA and with reduced post-TJA complications. However, bariatric surgery did not reduce the risk for revision surgery for either TKA or THA.
-
The state of Maryland was granted a waiver by the Center for Medicare and Medicaid Services to implement a Global Budget Revenue (GBR) reimbursement model. This study aims to compare (1) costs of inpatient hospital stays; (2) postacute care costs; (3) lengths of stay (LOS); and (4) discharge disposition who underwent primary total hip arthroplasty at a single Maryland-based orthopedic institution before and after the implementation of GBR. ⋯ There was a significant decrease in inpatient costs ($26,575 vs $23,712), an increase in mean home health costs ($627 vs 1608), and a decrease in mean durable medical equipment costs ($604 vs $82) and LOS (2.92 days vs 2.33 days). There was an increase in discharge to home rates (72.3% vs 78.9%) and a decrease in discharge to acute rehabilitation (4.3% vs 1.8%) CONCLUSION: Under the GBR model, our institution experienced significant cost savings during the inpatient and postacute care episodes. Thus, GBR may serve as a viable solution to reducing costs to Medicare for high-volume arthroplasty institutions with a large Medicare population. Multicentered studies are needed to verify our results.