Total Joint Replacement Surgery: Does Day of Surgery Matter? Raghuveer C. Muppavarapu MD, Ran Schwarzkopf MD, Elizabeth Matzkin MD, Charles Cassidy MD, Eric L. Smith MD PII: DOI: Reference:
S0883-5403(14)00401-X doi: 10.1016/j.arth.2014.06.004 YARTH 54029
To appear in:
Journal of Arthroplasty
Received date: Revised date: Accepted date:
25 March 2014 25 May 2014 4 June 2014
Please cite this article as: Muppavarapu Raghuveer C., Schwarzkopf Ran, Matzkin Elizabeth, Cassidy Charles, Smith Eric L., Total Joint Replacement Surgery: Does Day of Surgery Matter?, Journal of Arthroplasty (2014), doi: 10.1016/j.arth.2014.06.004
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI P
Raghuveer C. Muppavarapu, M.D. a
T
Total Joint Replacement Surgery: Does Day of Surgery Matter?
Ran Schwarzkopf, M.D. b
SC
Elizabeth Matzkin, M.D. c Charles Cassidy, M.D. d
NU
Eric L. Smith, M.D. e
MA
A. Resident, Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA B. Assistant Clinical Professor of Orthopaedic Surgery, University of California, Irvine, CA
ED
C. Assistant Professor, Harvard Medical School, Boston, MA D. Orthopaedist-in-Chief, Associate Professor, Chairman, Tufts University School of Medicine, Boston,
PT
MA
E. Chief of Arthroplasty Service, Assistant Professor, Tufts University School of Medicine, Boston, MA
CE
Study Performed at Tufts University School of Medicine and University of California, Irvine Key Words: Total Joint Arthroplasty, Length of stay
AC
Financial Disclosure: No financial support was received in connection with this study.
Corresponding Author: Eric L. Smith, M.D. Tufts Medical Center 800 Washington Street, Box 306 Boston MA 02111 T: 617- 636-5159 F: 617-636-5178 E: [email protected]
1
ACCEPTED MANUSCRIPT
Key Words: Total joint Arthroplasty; Length of Stay; Day of Surgery
T
Length of stay (LOS) after Total Joint Arthroplasty (TJA) impacts the expense to the
RI P
hospital. Our purpose was to evaluate the impact that day of surgery has on postoperative LOS. 547 patients who had a primary TJA at two tertiary care hospitals were identified retrospectively. TJA patients admitted on day of surgery and who had primary elective
SC
surgery were included in our sample. Patients were subdivided into one of four groups: those who had operations on Monday, Tuesday, Thursday, and Friday respectively.
NU
Patients who had surgery on Thursday and Friday had significantly longer LOS when compared to Monday and Tuesday. This variation in LOS between the groups may be
MA
due to inconsistencies in weekend functionality, less experienced part-time staffing, and
AC
CE
PT
ED
inaccessibility of rehabilitation personnel.
Introduction: Total joint arthroplasty (TJA) is a safe and effective treatment for advanced arthritis of the hip and knee. Over 90% of TJA patients report improved function and a reduction in 2
ACCEPTED MANUSCRIPT pain following their procedure.9 In the United States, TJA rates nearly doubled from 2000 to 2009, increasing from 400,000 to700,000 cases annually.6 As the annual number of TJA cases increase, so does concern regarding the high costs associated. Two of the
RI P
T
most substantial expenses are LOS after the procedure and implant costs.25
In efforts to curb costs associated with extended stay, critical care pathways have been
SC
implemented, effectively decreased LOS for many TJA patients resulting in savings of up to $3,000 per day reduced.25 Most notable however is that reduced LOS, when combined
NU
with an accelerated rehabilitation program, can actually improve patient function.3,8,16 This research was designed to evaluate variations in LOS in relation to day of surgery.
MA
The implications of the results from this study have the potential to improve patient outcomes and decrease hospital expenses.
ED
Methods:
After approval was obtained from the Tufts Medical Center IRB, we perfomed a
PT
retrospective review of all primary TJA procedures performed over a two year period, from March 2011 to April 2013, by two fellowship trained surgeons at Tufts Medical
CE
Center and University of California Irvine Medical Center. Our cohort included a total of 547 patients all of whom underwent primary total hip or knee arthoplasty. In order to
AC
avoid type II error (p
S0883-5403(14)00401-X doi: 10.1016/j.arth.2014.06.004 YARTH 54029
To appear in:
Journal of Arthroplasty
Received date: Revised date: Accepted date:
25 March 2014 25 May 2014 4 June 2014
Please cite this article as: Muppavarapu Raghuveer C., Schwarzkopf Ran, Matzkin Elizabeth, Cassidy Charles, Smith Eric L., Total Joint Replacement Surgery: Does Day of Surgery Matter?, Journal of Arthroplasty (2014), doi: 10.1016/j.arth.2014.06.004
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
RI P
Raghuveer C. Muppavarapu, M.D. a
T
Total Joint Replacement Surgery: Does Day of Surgery Matter?
Ran Schwarzkopf, M.D. b
SC
Elizabeth Matzkin, M.D. c Charles Cassidy, M.D. d
NU
Eric L. Smith, M.D. e
MA
A. Resident, Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, MA B. Assistant Clinical Professor of Orthopaedic Surgery, University of California, Irvine, CA
ED
C. Assistant Professor, Harvard Medical School, Boston, MA D. Orthopaedist-in-Chief, Associate Professor, Chairman, Tufts University School of Medicine, Boston,
PT
MA
E. Chief of Arthroplasty Service, Assistant Professor, Tufts University School of Medicine, Boston, MA
CE
Study Performed at Tufts University School of Medicine and University of California, Irvine Key Words: Total Joint Arthroplasty, Length of stay
AC
Financial Disclosure: No financial support was received in connection with this study.
Corresponding Author: Eric L. Smith, M.D. Tufts Medical Center 800 Washington Street, Box 306 Boston MA 02111 T: 617- 636-5159 F: 617-636-5178 E: [email protected]
1
ACCEPTED MANUSCRIPT
Key Words: Total joint Arthroplasty; Length of Stay; Day of Surgery
T
Length of stay (LOS) after Total Joint Arthroplasty (TJA) impacts the expense to the
RI P
hospital. Our purpose was to evaluate the impact that day of surgery has on postoperative LOS. 547 patients who had a primary TJA at two tertiary care hospitals were identified retrospectively. TJA patients admitted on day of surgery and who had primary elective
SC
surgery were included in our sample. Patients were subdivided into one of four groups: those who had operations on Monday, Tuesday, Thursday, and Friday respectively.
NU
Patients who had surgery on Thursday and Friday had significantly longer LOS when compared to Monday and Tuesday. This variation in LOS between the groups may be
MA
due to inconsistencies in weekend functionality, less experienced part-time staffing, and
AC
CE
PT
ED
inaccessibility of rehabilitation personnel.
Introduction: Total joint arthroplasty (TJA) is a safe and effective treatment for advanced arthritis of the hip and knee. Over 90% of TJA patients report improved function and a reduction in 2
ACCEPTED MANUSCRIPT pain following their procedure.9 In the United States, TJA rates nearly doubled from 2000 to 2009, increasing from 400,000 to700,000 cases annually.6 As the annual number of TJA cases increase, so does concern regarding the high costs associated. Two of the
RI P
T
most substantial expenses are LOS after the procedure and implant costs.25
In efforts to curb costs associated with extended stay, critical care pathways have been
SC
implemented, effectively decreased LOS for many TJA patients resulting in savings of up to $3,000 per day reduced.25 Most notable however is that reduced LOS, when combined
NU
with an accelerated rehabilitation program, can actually improve patient function.3,8,16 This research was designed to evaluate variations in LOS in relation to day of surgery.
MA
The implications of the results from this study have the potential to improve patient outcomes and decrease hospital expenses.
ED
Methods:
After approval was obtained from the Tufts Medical Center IRB, we perfomed a
PT
retrospective review of all primary TJA procedures performed over a two year period, from March 2011 to April 2013, by two fellowship trained surgeons at Tufts Medical
CE
Center and University of California Irvine Medical Center. Our cohort included a total of 547 patients all of whom underwent primary total hip or knee arthoplasty. In order to
AC
avoid type II error (p
