Preventing hospital readmissions and limiting the complications associated with total joint arthroplasty

Stephen Yu, Kevin Lloyd Garvin, William L. Healy, Vincent D. Pellegrini, Richard Iorio

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Total joint arthroplasty is a highly successful surgical procedure for patients with painful arthritic joints. The increasing prevalence of the procedure is generating significant expenditures in the American healthcare system. Healthcare payers, specifically the Center for Medicare and Medicaid Services, currently target total joint arthroplasty as an area for healthcare cost-savings initiatives, resulting in increased scrutiny surrounding orthopaedic care, health resource utilization, and hospital readmissions. Identifying the complications associated with total hip and total knee arthroplasty that result in readmissions will be critically important for predictive modeling and for decreasing the number of readmissions following total joint arthroplasty. Additionally, improving perioperative optimization, providing seamless episodic care, and intensifying posthospital coordination of care may result in a decreasing number of unnecessary hospital readmissions. Identified modifiable risk factors that significantly contribute to poor clinical outcome following total joint arthroplasty include morbid obesity; poorly controlled diabetes and nutritional deficiencies; Staphylococcus aureus colonization; tobacco use; venous thromboembolic disease; cardiovascular disease; neurocognitive, psychological, and behavioral problems; and physical deconditioning and fall risk. Both clinical practice and research will be enhanced if there is standardization of defined total joint arthroplasty complications and utilization of stratification schemes to identify high-risk patients. Subsequently, clinical intervention would be warranted to address modifiable risk factors before proceeding with total joint arthroplasty.

Original languageEnglish (US)
Pages (from-to)e60-e71
JournalJournal of the American Academy of Orthopaedic Surgeons
Volume23
Issue number11
DOIs
StatePublished - Nov 1 2015

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Patient Readmission
Arthroplasty
Joints
Delivery of Health Care
Centers for Medicare and Medicaid Services (U.S.)
Knee Replacement Arthroplasties
Morbid Obesity
Cost Savings
Health Resources
Tobacco Use
Health Expenditures
Malnutrition
Health Care Costs
Arthritis
Orthopedics
Staphylococcus aureus
Hip
Cardiovascular Diseases
Psychology
Research

Keywords

  • complications
  • prevention
  • total joint arthroplasty

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Preventing hospital readmissions and limiting the complications associated with total joint arthroplasty. / Yu, Stephen; Garvin, Kevin Lloyd; Healy, William L.; Pellegrini, Vincent D.; Iorio, Richard.

In: Journal of the American Academy of Orthopaedic Surgeons, Vol. 23, No. 11, 01.11.2015, p. e60-e71.

Research output: Contribution to journalArticle

Yu, Stephen ; Garvin, Kevin Lloyd ; Healy, William L. ; Pellegrini, Vincent D. ; Iorio, Richard. / Preventing hospital readmissions and limiting the complications associated with total joint arthroplasty. In: Journal of the American Academy of Orthopaedic Surgeons. 2015 ; Vol. 23, No. 11. pp. e60-e71.
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