Surgical technology international
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There is increasing pressure from Centers for Medicare and Medicaid Services (CMS) to report quality measures for all hospitalizations. These quality measures are determined based on results from satisfaction surveys, such as Press Ganey® (PG) (Press Ganey® Performance Solutions, Wakefield, Massachusetts). Included in this particular survey element are questions regarding staff, including nurses and doctors, as well as items such as pain control. The results of these surveys will dictate the amount doctors are compensated for their services. Therefore, this study was undertaken to evaluate the effect of treating orthopaedists and nurses, as well as pain control, on PG surveys in patients who underwent total knee arthroplasty (TKA). Specifically, we aimed to ascertain the effect of these factors on how post-TKA patients perceive: 1) their orthopaedist, and 2) their overall surgical experience. ⋯ We found that perception of pain control in post-TKA patients affects perception of the treating orthopaedists, as well as their overall surgical experience. In addition, perception of orthopaedists and nurses both outweigh perception of pain control on overall surgical experience, with nurses being the most important. Orthopaedists should focus on staff education-particularly nurses-and educate them in order to optimize results on PG surveys and, ultimately, improve patient satisfaction. Further studies should correlate current standardized scoring systems and questionnaires for TKA with PG surveys in order to recognize gaps that need to be bridged to improve post-TKA patient satisfaction.
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A multitude of vascular closure devices (VCDs) are currently on the market for femoral arteriotomy closure after diagnostic and interventional angiography. Randomized, controlled trials (RCTs) comparing these devices to manual compression (MC) and their effect on time to hemostasis, time to ambulation, time to discharge, and immediate as well as long term complications have been studied. A systematic and through review of these evaluations and outcomes has not previously been performed. ⋯ Overall, the review of 34 RCTs demonstrates the utility of VCDs has shortened time to hemostasis, ambulation, and discharge compared to patients receiving MC. Over the last decade, with emphasis on and implementation of same-day procedures, use of VCDs has resulted in a reduction in time to discharge to half a day and a significant decrease in cost. Overall complication rates are similar, but vary between different devices on the market. Better short-term quality of life has also been described with the use of VCDs compared to MC. Further clinical and financial improvements may be found as newer technological advances of VCDs become available.
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Comparative Study
Liposomal Bupivacaine Suspension, Can Reduce Length of Stay and Improve Discharge Status of Patients Undergoing Total Hip Arthroplasty.
To ensure good rehabilitation and improved outcomes following total hip arthroplasty (THA), optimal pain control is necessary. Newer methods of pain control have been advocated, as current modalities have been associated with undesirable side effects and serious complications. One such modality is liposomal bupivacaine, which provides long-acting, slow-release analgesia. The purpose of this study was to evaluate: (1) lengths of hospital stay and (2) the discharge status of patients who underwent THA with liposomal bupivacaine compared to a cohort who received standard analgesic regimens. ⋯ Liposomal bupivacaine appears to be an effective pain relief modality that leads to reduced lengths of hospital stay and increased rates of discharge to home. This may be an appropriate addition for the analgesic armamentarium in patients who undergo THA.
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Readmission rates remain a concern following total hip arthroplasty (THA). This study: 1) evaluated 30-day, 90-day, and total readmission rates after THAs; 2) assessed causes of readmission; 3) determined differences in demographic factors between those who were and were not readmitted; and 4) compared readmission rates to other large-scale studies. We retrospectively reviewed 232 primary THAs (224 patients) using the same prosthesis at 7 institutions. ⋯ No differences existed in mean age, gender, and body mass index between readmitted patients and the remainder of the population. We observed lower readmission rates when compared with large cohort studies. The positive performance of the prosthesis may have contributed to the lower readmission rates.
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Many scoring systems have been developed that serve to evaluate outcomes following total hip arthroplasty (THA). However, most systems focus on specific aspects of a patient's recovery rather than investigating a broad spectrum of parameters, which prevent physicians from obtaining a sufficient impression of a patient's recovery. Therefore, we evaluated existing scoring systems to assess the outcome categories included and parameters of interest. ⋯ Patient outcomes can be evaluated by the use of scoring systems in an effort to determine the effectiveness of THA in regaining function and improving quality of life. Determining the frequency and importance of parameters in current scoring systems may allow for a more accurate and purposeful assessment of post-operative function and patient satisfaction. Understanding what is evaluated in existing scoring systems may shed light on the future development of a comprehensive outcome questionnaire.