Health Policy & EconomicsRapid Recovery Total Joint Arthroplasty is Safe, Efficient, and Cost-Effective in the Veterans Administration Setting
Section snippets
Materials and Methods
On July 1, 2016, a new rapid recovery TJA protocol was implemented at our institution’s associated VA Hospital. This protocol was based on current literature and was approved by the Iowa City VA Pharmacy and Therapeutic Committee as well as the Clinical Executive Board. It was developed with multidisciplinary input from orthopedic staff and residents, midlevel providers, anesthesia staff, physical therapists, pharmacists, nurses, and social workers. Briefly, the protocol consisted of required
Patient Demographics
In total, 252 primary TJAs (THA = 72, TKA = 180) were analyzed in 220 patients: 174 in the pre-protocol cohort and 78 in the protocol cohort. Five patients had 1 surgery in both the pre-protocol and protocol periods. There were 19 patients with 2 surgeries in the pre-protocol period and no surgery in the protocol period, and there were 8 patients with 2 surgeries in the protocol period but no surgery in the pre-protocol period. For those receiving multiple interventions, each surgery and its
Discussion
It has been well documented that institutional clinical pathways for TJA patients can reduce costs and improve patient care in some patient populations [1], [2], [3], [4], [5], [6]. Caring for Veterans in the VA hospital setting, however, presents unique challenges in the form of increased patient complexity and systemic obstacles. We sought to determine the effect and feasibility of implementing a comprehensive rapid recovery perioperative TJA protocol in the VA setting.
As summarized by Sculco
Conclusion
In the VA hospital setting, rapid recovery TJA is both safe and effective. Implementation of a rapid recovery protocol resulted in decreased hospital LOS and an increase in patients discharging directly home without increasing readmission or complication rates. These changes also decreased the average cost of TJA by approximately 10%. Such protocols are important for improved patient care and essential for cost control as we transition into an era of value-based arthroplasty.
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Cited by (29)
Determining factors on length of stay in primary total knee arthroplasty patients using enhanced recovery protocol after surgery (ERAS) pathway
2024, Revista Espanola de Cirugia Ortopedica y TraumatologiaIncreased Patient-Level Payment After Removal of Total Knee Arthroplasty From the Inpatient-Only List
2022, Journal of ArthroplastyRapid Recovery Is Feasible for Aseptic Revision Total Knee Arthroplasty at an Academic Medical Center
2021, Arthroplasty TodayCitation Excerpt :Postoperatively, patients are mobilized immediately as they begin their rehabilitation. Rapid recovery care pathways safely decrease LOS and allow home discharge after primary TKA [6,7]. Shorter LOS decreases the risk of venous thromboembolism [8].
Home Discharge Has Increased After Total Hip Arthroplasty, However Rates Vary Between Large Databases
2021, Journal of ArthroplastyCitation Excerpt :Reduction in LOS, increased discharge home, and reduction in perioperative complications resulting in readmission or reoperation are likely the result of improvements in preoperative patient optimization, expansion of multimodal analgesia, and patient education before these elective procedures. Interventions in the preoperative period have been shown to be highly successful in reducing LOS and decreasing overall costs of care [14–24]. Other advancements in arthroplasty practice, such as improvements in surgical technique, greater understanding of the hip-spine relationship, or utilization of larger femoral heads and dual-mobility components, may also have contributed to the findings observed in this study.
Outpatient Mastectomy: Factors Influencing Patient Selection and Predictors of Return to Care
2021, Journal of the American College of SurgeonsCitation Excerpt :Other predictors of successful SHR included multimodal pain management. Multimodal anesthesia is one of the overarching principles of ERAS, which has been shown to decrease LOS across many surgical subspecialties.13,24,25 Smaller studies have found that applying ERAS principles to patients undergoing breast operations enabled same-day discharge without any effect on complication rates.26,27
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.07.004.