Treatment of Osteoarthritis of the Knee: Evidence-Based Guideline, 2nd Edition, is based on a systematic review of the current scientific and clinical research. This guideline contains 15 ...recommendations, replaces the 2008 AAOS clinical practice guideline, and was reevaluated earlier than the 5-year recommendation of the National Guideline Clearinghouse because of methodologic concerns regarding the evidence used in the first guideline. The current guideline does not support the use of viscosupplementation for the treatment of osteoarthritis of the knee. In addition, the work group highlighted the need for better research in the treatment of knee osteoarthritis.
Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in ...surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay.
Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity.
From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval CI, $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed.
Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift toward younger population groups, reduction in length of stay remains an important target for procedure-level cost containment under emerging payment models.
Management of hip fractures in the elderly Roberts, Karl C; Brox, W Timothy; Jevsevar, David S ...
Journal of the American Academy of Orthopaedic Surgeons,
02/2015, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The purpose of this clinical practice guideline is to help improve treatment and management of hip fractures in the elderly based on current best evidence. The guideline contains twenty-five ...recommendations, including both diagnosis and treatment. Of those recommendations, strong evidence supports regional analgesia to improve preoperative pain control, similar outcomes for general or spinal anesthesia, arthroplasty for patients with unstable (displaced) femoral neck fractures, the use of a cephalomedullary device for the treatment of patients with subtrochanteric or reverse obliquity fractures, a blood transfusion threshold of no higher than 8 g/dL in asymptomatic postoperative patients, intensive physical therapy postdischarge, use of an interdisciplinary care program in patients with mild to moderate dementia, and multimodal pain management after hip fracture surgery. In addition to the recommendations, the work group highlighted the need for better research in the treatment of hip fractures.
Many surgeons require or request weight loss among morbidly obese patients (those with a body mass index BMI of ≥40 kg/m) before undergoing total knee arthroplasty. We sought to determine how much ...weight reduction was necessary to improve operative time, length of stay, discharge to a facility, and physical function improvement.
Using a retrospective review of cohort data that were prospectively collected from 2011 to 2016 at 1 tertiary institution, we identified 203 patients who were morbidly obese at least 90 days before the surgical procedure and had their BMI measured again at the immediate preoperative visit. All heights and weights were clinically measured. We used logistic and linear regression models that adjusted for preoperative age, sex, year of the surgical procedure, bilateral status, physical function (Patient-Reported Outcomes Measurement Information System PROMIS-10 physical component score PCS), mental function (PROMIS-10 mental component score MCS), and the Charlson Comorbidity Index.
Of the 203 patients in the study, 41% lost at least 5 pounds (2.27 kg) before the surgical procedure, 29% lost at least 10 pounds (4.54 kg), and 14% lost at least 20 pounds (9.07 kg). Among morbidly obese patients, losing 20 pounds before a total knee arthroplasty was associated with lower adjusted odds of discharge to a facility (odds ratio OR, 0.28 95% confidence interval (CI), 0.09 to 0.94; p = 0.039), lower odds of extended length of stay of at least 4 days (OR, 0.24 95% CI, 0.07 to 0.88; p = 0.031), and an absolute shorter length of stay (mean difference, -0.87 day 95% CI, -1.39 to -0.36 days; p = 0.001). There were no differences in operative time or PCS improvement. Losing 5 or 10 pounds was not associated with differences in any outcome.
Losing at least 20 pounds before total knee arthroplasty was associated with shorter length of stay and lower odds of facility discharge for morbidly obese patients, even while most patients remained morbidly or severely obese. Although there were no differences in operative time or physical function improvement, this has considerable implications for patient burden and cost reduction. Patients and providers may want to focus on larger preoperative weight loss targets.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The novel coronavirus, severe acute respiratory coronavirus 2 (SARS-CoV-2), pandemic has delivered a profound and negative impact on the United States. The suspension of elective surgeries including ...arthroplasty will have a lasting effect on all stakeholders including patients, physicians, and healthcare organizations within the US healthcare system. Resumption of elective hip and knee arthroplasty will need to be carefully focused. The purpose of this work is to address potential strategies, concerns, and regulatory barriers in restarting elective hip and knee arthroplasty in the United States.
Introduction:
Periprosthetic hip fractures (PPFX) are serious complications that result in increased morbidity, mortality and healthcare costs. Decreasing hospital readmissions has been a recent ...healthcare focus, but little is known about the overall costs associated with PPFX or the risk factors associated with readmissions. We investigated patient demographics, treatment types, 30- and 90-day readmission rates, direct costs, and patient risk factors associated with PPFX readmission.
Methods:
We used the 2013 Nationwide Readmissions Database to select patients who underwent total hip arthroplasty (THA), revision THA, and PPFX treated with open reduction internal fixation (ORIF) or revision THA. Survival analysis was used to evaluate the 90-day all-cause hospital readmission rate, and risk factors were identified using a Cox proportional hazards model, adjusting for patient and hospital characteristics.
Results:
We identified 1269 patients with PPFX treated with ORIF and 3254 treated with revision THA. 90-day readmissions were 20.9% and 27.3%, respectively. Patients with PPFX were older, female, and had multiple medical comorbidities. Patient factors associated with increased risk of readmission include: age; comorbidities; and discharge to skilled nursing facility; Medicare or Medicaid insurance. Hospital factors associated with increased risk of readmission include: large hospitals; nonprofits; metropolitan and teaching hospitals. The cost of readmission for PPFX treated with ORIF was $17,206 and revision THA was $16,504.
Discussion:
Periprosthetic hip fractures have high rates of hospital readmission, implying a significant burden to the healthcare system. Identifying risk factors is an important step towards identifying treatment pathways that can improve outcomes.
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