Browsing by Subject "Arthroplasty"

Now showing 1 - 7 of 7
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    Doctor when can I drive? A systematic review and meta-analysis of return to driving after total hip arthroplasty
    (Sage, 2023) Patel, Purva V.; Giannoudis, Vasileios P.; Palma, Samantha; Guy, Stephen P.; Palan, Jeya; Pandit, Hemant; Van Duren, Bernard H.; Graduate Medical Education, School of Medicine
    Background/objective: Advice given to patients on driving resumption after total hip arthroplasty (THA) is inconsistent. Due to a lack of clear guidelines, surgeons' recommendations range between 4-8 weeks after surgery to resume driving. Delays in driving return can have detrimental social and economic impact. However, it is important to ensure patients only resume driving once safe. This study presents a systematic review and meta-analysis of driving simulation studies after THA to establish when patients can safely return to driving postoperatively. Methods: A systematic review and meta-analysis using PRISMA guidelines was undertaken. Titles and abstracts were screened for inclusion, data was extracted, and studies assessed for bias risk. Review Manager, was used for statistical analysis. Values for brake reaction time (BRT) were included for meta-analysis. Results: 14 articles met the inclusion criteria. Of these, 7 measured BRT and were included in the meta-analysis. Pooled means of both right and left THA showed BRT around or above preoperative baseline at 1 week, 2 weeks and 3 weeks, and below baseline at 6 weeks, 12 weeks, 32 weeks and 52 weeks. Of these, the pooled means at 6, 32, and 52 weeks were significant (p < 0.05).Studies not meeting meta-analysis inclusion criteria were included in a qualitative analysis, examining self-reported postoperative driving return times which ranged from 6 days to over a year or in rare cases, never. Majority of patients (n = 960) self-reported driving return within approximately 6 weeks (pooling of mean values 32.9 days). Conclusions: The mean return to driving time recommended in the literature was 4.5 weeks. Based upon BRT meta-analysis, a return to baseline braking performance was noted at 6 weeks postoperatively. However, driving is a complex skill, and patient recommendation should be individualised based on factors such as vehicle transmission type, THA technique, surgical side, medication and comorbidities.
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    Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?
    (Elsevier, 2020-07-16) Kraus, Kent R.; Buller, Leonard T.; Caccavallo, Peter; Ziemba-Davis, Mary; Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    Introduction: In recent years, cost containment relative to patent safety and quality of care for total joint arthroplasty (TJA) has been a key focus for the Centers for Medicare and Medicaid Services (CMS) spawning significant research and programmatic change, including a move toward early discharge and outpatient TJA. TJA outpatients receive few, if any, medical interventions prior to discharge, but the type and quantity of medical interventions provided for TJA patients who stay overnight in the hospital is unknown. This study quantified the nature, frequency, and outcome of interventions occurring overnight after primary TJA. Methods: 1,725 consecutive primary unilateral TJAs performed between 2012 and 2017 by a single surgeon in a rapid-discharge program, managed by a perioperative internal medicine specialist, were reviewed. Medical records were examined for diagnostic tests, treatments, and procedures performed, results of interventions, and all-cause readmissions. Recorded interventions included any that varied from the preoperative treatment plan, were beyond standard-of-care, and could not be completed at home. Results: 759 patients were discharged on postoperative day one. 84% (641/759) received no medical interventions during their overnight hospital stay. Twelve (1.6%) received diagnostic tests, 90 (11.9%) received treatments, and 29 (3.8%) received procedures. 92% (11/12) of diagnostic tests were negative, 66% of 100 treatments in 90 patients were intravenous fluids for oliguria or hypotension, and all procedures were in/out catheterizations for urinary retention. 90-day all cause readmission rates were similar in patients who received (2.5%) and did not receive (3.3%) a clinical intervention. Conclusion: The majority of patients received no overnight interventions, suggesting unnecessary costly hospitalization. The most common issues addressed were oliguria, urinary retention, and hypotension. Protocols to prevent these conditions would facilitate outpatient TJA, improve patient safety, and reduce costs.
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    Opioid use prior to knee arthroplasty in patients who catastrophize about their pain: preoperative data from a multisite randomized clinical trial
    (Dovepress, 2018-08-21) Riddle, Daniel L.; Slover, James D.; Ang, Dennis C.; Bair, Matthew J.; Kroenke, Kurt; Perera, Robert A.; Dumenci, Levent; Medicine, School of Medicine
    Background: Opioid use rates prior to knee arthroplasty (KA) among people who catastrophize about their pain are unknown. We determined prevalence of opioid use and compared patterns of preoperative opioid use and oral morphine equivalent (OME), a measure of daily opioid dose, across varied geographic sites. We also determined which baseline variables were associated with opioid use and OME. Patients and methods: Preoperative opioid use data described type of opioid, dosage, and frequency among 397 patients scheduled for KA. Demographic, knee-related pain, and psychological distress dimensions were examined to identify variables associated with opioid use and opioid dose (OME). Opioid use prevalence and OME were compared across the four sites. A three-level censored regression determined variables associated with opioid use and OME. Results: The overall opioid use prevalence was 31.7% (95% confidence interval [CI] = 27.0, 36.3) and varied across sites from 15.9% (95% CI = 9.0, 22.8) to 51.2% (95% CI = 40.5, 61.9). After adjustment, patients using opioids were more likely to be younger, African American, and have higher self-efficacy and comorbidity scores (P < 0.05). The only variable independently associated with OME was lower depressive symptoms (P < 0.05). Conclusion: People who catastrophized prior to KA did not demonstrate increased preoperative opioid use based on current evidence, but variation in the prevalence of opioid use across study sites was substantial. Variables associated with opioid use were non-modifiable demographic and comorbidity variables.
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    Techniques and Strategies to Optimize Efficiencies in the Office and Operating Room: Getting Through the Patient Backlog and Preserving Hospital Resources
    (Elsevier, 2021) Meneghini, R. Michael; Orthopaedic Surgery, School of Medicine
    The effects of the coronavirus disease 2019 pandemic are pervasive and have decreased the volume of hip and knee arthroplasty procedures since the mandated cessation of elective surgical procedures at the height of the pandemic in early 2020. Therefore, a backlog of patients in need of these elective procedures is a probable consequence and increased productivity and efficiency in patient care delivery is essential now and into the future. This article outlines multiple strategies and techniques to develop and optimize efficiency in the hip and knee arthroplasty practice. Techniques for increasing surgical efficiency are detailed, along with perioperative strategies in the hospital, ambulatory surgery center, and office settings are outlined and discussed.
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    Total Joint Arthroplasty and Sleep: The State of the Evidence
    (Elsevier, 2024-04-24) Pettit, Robert J.; Gregory, Brandon; Stahl, Stephanie; Buller, Leonard T.; Deans, Christopher; Medicine, School of Medicine
    Background: As the number of total hip and knee arthroplasties (TJA) performed increases, there is heightened interest in perioperative optimization to improve outcomes. Sleep is perhaps one of the least understood perioperative factors that affects TJA outcomes. The purpose of this article is to review the current body of knowledge regarding sleep and TJA and the tools available to optimize sleep perioperatively. Methods: A manual search was performed using PubMed for articles with information about sleep in the perioperative period. Articles were selected that examined: sleep and pain in the perioperative period; the effect of surgery on sleep postoperatively; the relationship between sleep and TJA outcomes; risk factors for perioperative sleep disturbance; the effect of anesthesia on sleep; and the efficacy of interventions to optimize sleep perioperatively. Results: Sleep and pain are intimately associated; poor sleep is associated with increased pain sensitivity. Enhanced sleep is associated with improved surgical outcomes, although transient sleep disturbances are normal postoperatively. Risk factors for perioperative sleep disturbance include increasing age, pre-existing sleep disorders, medical comorbidities, and type of anesthesia used. Interventions to improve sleep include optimizing medical comorbidities preoperatively, increasing sleep time perioperatively, appropriating sleep hygiene, using cognitive behavioral therapy, utilizing meditation and mindfulness interventions, and using pharmacologic sleep aids. Conclusions: Sleep is one of many factors that affect TJA. As we better understand the interplay between sleep, risk factors for suboptimal sleep, and interventions that can be used to optimize sleep, we will be able to provide better care and improved outcomes for patients.
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    Trends in outpatient shoulder arthroplasty during the COVID-19 (coronavirus disease 2019) era: increased proportion of outpatient cases with decrease in 90-day readmissions
    (Elsevier, 2022) Seetharam, Abhijit; Ghosh, Priyanka; Prado, Ruben; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Background: The COVID-19 (coronavirus disease 2019) pandemic has placed an increased burden on health care resources, with hospitals around the globe canceling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study was to investigate trends in total shoulder arthroplasty (TSA) during the COVID-19 era with respect to outpatient surgery and postoperative complications. Methods: We conducted a retrospective chart review of all primary anatomic and reverse TSAs performed at our health institution over a 3-year period (January 2018 to January 2021). All cases performed prior to March 2020 were considered the "pre-COVID-19 era" cohort. All cases performed in March 2020 or later comprised the "COVID-19 era" cohort. Patient demographic characteristics and medical comorbidities were also collected to appropriately match patients from the 2 cohorts. Outcomes measured included type of patient encounter (outpatient vs. inpatient), total length of stay, and 90-day complications. Results: A total of 567 TSAs met the inclusion criteria, consisting of 270 shoulder arthroplasty cases performed during the COVID-19 era and 297 cases performed during the pre-COVID-19 era. There were no significant differences in body mass index, American Society of Anesthesiologists score, smoking status, or distribution of pertinent medical comorbidities between the 2 examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in an outpatient setting. This was significantly higher than the percentage in the pre-COVID-19 era, with only 4.5% of cases performed in an outpatient setting (P < .0001). The average length of stay was significantly reduced in the COVID-19 era cohort (0.81 days vs. 1.45 days, P < .0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. No significant difference in 90-day emergency department visits, 90-day venous thromboembolism events, or 90-day postoperative infections was observed between the 2 cohorts. Conclusion: We found a significant increase in the number of outpatient shoulder arthroplasty cases being performed at our health institution during the COVID-19 era, likely owing to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and a significant decrease in 90-day readmissions compared with the pre-COVID-19 era. The study data suggest that outpatient TSA can be performed in a safe and efficient manner in the appropriate patient cohort.
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    Trends in Outpatient Shoulder Arthroplasty during the COVID-19 era: Increased Proportion of Outpatient Cases with Decrease in 90-day Readmissions
    (Elsevier, 2022-01) Seetharam, Abhijit; Ghosh, Priyanka; Prado, Ruben; Badman, Brian L.; Orthopaedic Surgery, School of Medicine
    Background The COVID-19 pandemic has placed increased burden on healthcare resources, with hospitals around the globe cancelling or reducing most elective surgical cases during the initial period of the pandemic. Simultaneously, there has been an increased interest in performing outpatient total joint arthroplasty in an efficient manner while maintaining patient safety. The purpose of this study is to investigate trends in total shoulder arthroplasty during the COVID-19 era with respect to outpatient surgery and postoperative complications. Methods After approval from our Institution Review Board (IRB), a retrospective chart review was performed of all primary anatomic and reverse total shoulder arthroplasties at our health institution over a 3 year period (January 2018 – January 2021). All cases done prior to March 2020 were considered the “pre-COVID era” cohort. All cases after March 2020 were in the “COVID-19 era” cohort. Patient demographic and medical comorbidities were also collected to appropriately match patients from the two cohorts. Outcomes measured included patient encounter (outpatient versus inpatient), total length of stay, and 90 day complications. Results A total of 567 total shoulder arthroplasties met the inclusion criteria. There were 270 shoulder arthroplasty cases during the COVID-19 era, and 297 cases during the examined pre-COVID era. There were no significant differences in BMI, ASA score, smoking status, or distribution of pertinent medical comorbidities between the two examined cohorts. During the COVID-19 era, 31.8% of shoulder arthroplasties were performed in the outpatient setting. This was significantly higher than in the pre-COVID era, with only 4.5% of cases done in an outpatient setting (p < 0.0001). Average length of stay was significantly reduced in the COVID-19 era cohort (0.81 versus 1.45 days, p<0.0001). There was a significant decrease in 90-day readmissions during the COVID-19 era. 90 day ER visits, 90 day VTE, or 90 day postoperative infection were not significantly different between the two cohorts. Conclusion We found a significant increase in the number of outpatient shoulder arthroplasty cases being done at our health institution during the COVID-19 era, likely due to a multitude of factors including improved perioperative patient management and increased hospital burden from the COVID-19 pandemic. This increase in outpatient cases was associated with a significant reduction in average hospital length of stay and decrease in 90 day readmissions compared to the pre-COVID era. The data suggest that outpatient total shoulder arthroplasty can be performed in a safe and efficient manner in the appropriate patient cohort.