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Ademuyiwa AO, Bhangu A, Chakrabortee S, Glasbey J, Kamarajah SK, Ledda V, Li E, Morton D, Nepogodiev D, Picciochi M, Simoes JFF, Lapitan MC, Cheetham M, Forkman E, El-Boghdadly E, Ghosh D, Harrison EM, Hutchinson P, Lawani I, Aguilera ML, Martin J, Meara JG, Ntirenganya F, Medina ARDL, Tabiri S. Strategies to strengthen elective surgery systems during the SARS-CoV-2 pandemic: systematic review and framework development. Br J Surg 2024; 111:znad405. [PMID: 38300731 PMCID: PMC10833142 DOI: 10.1093/bjs/znad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 02/03/2024]
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LeBrun DG, Nguyen J, Fisher C, Tuohy S, Lyman S, Gonzalez Della Valle A, Ast MP, Carli AV. The Risk Assessment and Prediction Tool (RAPT) Score Predicts Discharge Destination, Length of Stay, and Postoperative Mobility after Total Joint Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00479-5. [PMID: 37182588 DOI: 10.1016/j.arth.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION Predicting an arthroplasty patient's discharge disposition, length of stay, and physical function is helpful because it allows for preoperative patient optimization, expectation management, and discharge planning. The goal of this study was to evaluate the ability of the Risk Assessment and Prediction Tool (RAPT) score to predict discharge destination, length of stay, and postoperative mobility in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS Primary unilateral TKAs (n=9,064) and THAs (n=8,649) performed for primary osteoarthritis at our institution from 2018 to 2021 (excluding March to June 2020) were identified using a prospectively maintained institutional registry. We evaluated the associations between preoperative RAPT score and (1) discharge destination, (2) length of stay, and postoperative mobility as measured by (3) successful ambulation on the day of surgery and (4) Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" score. RESULTS On multivariable analyses adjusting for multiple covariates, every one-point increase in RAPT score among TKA patients was associated with a 1.82-fold increased odds of home discharge (P<0.001), 0.22 days shorter length of stay (P<0.001), 1.13-fold increased odds of ambulating on postoperative day 0 (P<0.001), and 0.25-point higher AM-PAC score (P<0.001). Similar findings were seen among THAs. A RAPT score of 8 or higher was the most sensitive and specific cutoff to predict home discharge. CONCLUSION Among nearly 18,000 TKA and THA patients, RAPT score was predictive of discharge disposition, length of stay, and postoperative mobility. A RAPT score of 8 or higher was the most sensitive and specific cutoff to predict discharge to home. In contrast to prior studies of the RAPT score which have grouped TKAs and THAs together, this study ran separate analyses for TKAs and THAs and found that THA patients seemed to perform better than TKA patients with equal RAPT scores, suggesting that RAPT may behave differently between TKAs and THAs, particularly in the intermediate risk RAPT range.
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Affiliation(s)
- Drake G LeBrun
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021.
| | - Joseph Nguyen
- Biostatistics, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY, 10021
| | - Charles Fisher
- Acute Care Rehabilitation, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY, 10021
| | - Sharlynn Tuohy
- Acute Care Rehabilitation, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY, 10021
| | - Stephen Lyman
- Biostatistics, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY, 10021
| | | | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021
| | - Alberto V Carli
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70(th) Street, New York, NY 10021
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Stronach BM, Zhang X, Haas D, Iorio R, Anoushiravani A, Barnes CL. Worsening Arthroplasty Utilization With Widening Racial Variance During the COVID-19 Pandemic. J Arthroplasty 2022; 37:1227-1232. [PMID: 35276272 PMCID: PMC8904006 DOI: 10.1016/j.arth.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Elective arthroplasty surgery in the United States came to a near-complete halt in the spring of 2019 as a response to the COVID-19 pandemic. Racial disparity has been a long-term concern in healthcare with increased focus during the pandemic. The purpose of this study is to evaluate the effects of COVID-19 and race on arthroplasty utilization trends during the pandemic. METHODS We used 2019 and 2020 Center for Medicare and Medicaid Service fee-for-service claims data to compare arthroplasty volumes prior to and during the COVID-19 pandemic. We compared overall arthroplasty utilization rates between 2019 and 2020 and then sought to determine the effect of race and COVID-19, both independently and combined. RESULTS There was a decrease in primary total knee arthroplasty (-28%), primary total hip arthroplasty (-14%), primary total hip arthroplasty for fracture (-2%), and revision arthroplasty (-14%) utilization between 2019 and 2020. The highest decrease in overall arthroplasty utilization was in the Hispanic population (34% decrease vs 19% decrease in the White population). We found that a non-White patient was 39.9% (P < .001) less likely to receive a total joint arthroplasty prior to COVID-19. The COVID-19 pandemic further exacerbated the pre-existing racial differences in arthroplasty utilization by decreasing the probability of receiving a total joint arthroplasty for non-White patient by another 12.9% (P < .001). CONCLUSION We found an overall decreased utilization rate of arthroplasty during the COVID-19 pandemic with further decrease noted in all non-White populations. This raises significant concern for worsening racial disparity in arthroplasty caused by the ongoing pandemic.
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Affiliation(s)
- Benjamin M. Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Richard Iorio
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - C. Lowry Barnes
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR,Address correspondence to: C. Lowry Barnes, MD, Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR 72205
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The impact of the COVID-19 associated shutdown on orthopedic patient care. Arch Orthop Trauma Surg 2022; 143:2885-2892. [PMID: 35589981 PMCID: PMC9119384 DOI: 10.1007/s00402-022-04466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/25/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to the surge of COVID-19 cases in the US in early March 2020, health care facilities temporarily suspended elective and non-urgent medical procedures such as joint replacement surgeries. The aim of this study was to analyze the impact of the COVID-19 associated shutdown on orthopedic patient care at a specialized orthopedic hospital located at the epicenter of the COVID-19 pandemic. METHODS Patient volume of outpatient visits and joint replacement surgeries were analyzed and compared for 2019 and 2020. The volumes were further aligned with the timeline of governmental and institutional COVID-19 associated restrictions. RESULTS The annual surgery volume was reduced by 20.2% in 2020 and did not make up for the reduction experienced during the shutdown. The total number of patient visits decreased by 25.5% and new patient visits remained 25% lower at the end of 2020. Patient care and surgery volume recovered with declining SARS-CoV-2-cases but did not return to levels prior to the shutdown. During the second quarter of 2020, 28.5% of all patient visits were telehealth appointments. By the end of the year it dropped to 7.6%. There was a shift towards patient appointments at outpatient satellite offices. CONCLUSION Orthopedic providers faced a substantial disruption in outpatient and surgical volume. Telemedicine appointments were crucial for maintaining follow-up patient care and will be an important sector in future patient care. There has been a major push to utilize satellite offices outside the city center.
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Jungwirth-Weinberger A, Boettner F, Kapadia M, Diane A, Chiu YF, Lyman S, Fontana MA, Miller AO. History of COVID-19 Was Not Associated with Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement. Arthroplast Today 2021; 13:109-115. [PMID: 34909457 PMCID: PMC8660178 DOI: 10.1016/j.artd.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background The impact of previous SARS-CoV-2 infection on the morbidity of elective total joint arthroplasty (TJA) is not fully understood. This study reports on the association between previous COVID-19 disease, hospital length of stay (LOS), and in-hospital complications after elective primary TJA. Methods Demographics, comorbidities, LOS, and in-hospital complications of consecutive 340 patients with a history of COVID-19 were compared with those of 5014 patients without a history of COVID-19 undergoing TJA. History of COVID-19 was defined as a positive IgG antibody test for SARS-CoV-2 before surgery. All patients were given both antibody and polymerase chain reaction tests before surgery. Results Patients with a history of COVID-19 were more likely to be obese (43.8% vs 32.4%, P < .001), Black (15.6% vs 6.8%, P < .001), or Hispanic (8.5% vs 5.4%, P = .028) than patients without a history of COVID-19. COVID-19 treatment was reported by 6.8% of patients with a history of COVID-19. Patients with a history of COVID-19 did not have a significantly longer median LOS after controlling for other factors (for hip replacements, median 2.9 h longer, 95% confidence interval = −2.0 to 7.8, P = .240; for knee replacements, median 4.1 h longer, 95% confidence interval = −2.4 to 10.5, P = .214), but a higher percentage were discharged to a post–acute care facility (4.7% vs 1.9%, P = .001). There was no significant difference in in-hospital complication rates between the 2 groups (0/340 = 0.0% vs 22/5014 = 0.44%, P = .221). Conclusions We do not find differences in LOS or in-hospital complications between the 2 groups. However, more work is needed to confirm these findings, particularly for patients with a history of more severe COVID-19. Level of evidence II.
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Affiliation(s)
- Anna Jungwirth-Weinberger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Cantonal Hospital Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Milan Kapadia
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alioune Diane
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yu-Fen Chiu
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephen Lyman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mark Alan Fontana
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Weill Cornell Medical College, Department of Population Health Sciences, 1300 York Ave, New York, NY, 10065, USA
| | - Andy O Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Sanders J, Balcom C. Clinical leadership during the COVID-19 pandemic: Reflections and lessons learned. Healthc Manage Forum 2021; 34:316-319. [PMID: 34693767 PMCID: PMC8547230 DOI: 10.1177/08404704211044587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 has, and continues to, wreak havoc worldwide, and the healthcare system has been particularly challenged with personnel shortages, resource insecurity, mixed messages, and fear to name a few. At the outset, it was thought the pandemic would be short-lived, resulting in the enactment of disaster plans in hospitals. Such autocratic approaches are not always effective in the long-term; a servant leadership approach is more conducive to engaging teams, and this dyad structure supports effective leadership during challenging times. While there is not one right approach to leading through a pandemic, lessons learned from this pandemic are applicable when, not if, the next pandemic occurs.
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Affiliation(s)
- Jonathan Sanders
- 2757Department of Emergency Medicine, HCA Houston Healthcare North Cypress, Cypress, TX, USA
| | - Carl Balcom
- 16057HCA Healthcare. Baylor University Louise Herrington School of Nursing, Dallas, TX, USA
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Vaidya S, Berluti D, Irving JF, Girasole G, McCallum JD, Kolstad L, McLaughlin T. A COVID-19 Pivot Plan to Resume Elective Surgeries at the Hartford Healthcare Connecticut Orthopaedic Institute. Cureus 2021; 13:e15077. [PMID: 34150411 PMCID: PMC8208727 DOI: 10.7759/cureus.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The Connecticut Orthopaedic Institute (COI) conceptualized a Pivot Plan during an elective surgery moratorium at the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic with the goal of planning and executing orthopedic procedures safely. With the resumption of elective surgeries and the continued planning of surgical recovery over the months (and possibly years) to follow, facilities must brace themselves for repeat waves of COVID-19. Thereby, herein we share the Pivot Plan, its implementation process, evaluation of patient safety, and program performance during a pandemic. This could inform the efforts of other institutions seeking to restart non-emergent surgeries during similarly trying times in the future. Methods The COI formed a multidisciplinary team of leaders that met weekly to design a Pivot Plan and a dashboard to guide the resumption of surgeries and assess the performance of the Pivot Plan. The plan revolved around four domains: safety, space, staff, and supplies. It was implemented in two COI-affiliated facilities: MidState Medical Center (MMC) and St. Vincent’s Medical Center (SVMC). Monthly metrics from May to November 2020 were compared to the six-month averages for the pre-pandemic baseline period from September 2019 to February 2020. Results The total number (N) of elective orthopaedic cases prior to the pandemic pre-COVID averaged 372 cases per month for MMC and 197 cases for SVMC. During the pandemic post-COVID, N averaging at 361 for MMC and 243 for SVMC illustrates COI was able to perform elective surgeries amid a worsening pandemic. Same-day (SD) discharge rates for total joint arthroplasty (TJA) pre-COVID averaged 8% for MMC and 3% for SVMC. Post-COVID, the SD average was 16.7% for MMC and 11.4% for SVMC. This data indicates that orthopaedic providers were cognizant of length of stay in order to reduce the risk of in-hospital exposure to COVID-19. The 30-day readmission (30R) rate for TJA pre-COVID averaged 1.4% for MMC and 2.7% for SVMC. A high level of care and follow-up is reflected in a lower average 30R post-COVID, 1.1% for both MMC and SVMC. Transitions for TJA patients to their home settings after surgery also reflect the quality of care and the efficiency of the patient throughput process with necessary precautions in place. Post-COVID, the patient transition to home (T) averaged 98.1% for MMC and 97.5% for SVMC compared to T = 96.8% for MMC and 88% for SVMC pre-COVID. No patients experienced deep vein thrombosis or pulmonary embolism during the time period of the project. Positive COVID-19 diagnosis 23 days after discharge was 0% at MMC and 0.2% at SVMC. Conclusion The COI Pivot Plan was successfully implemented at two different hospitals offering elective orthopaedic surgeries to a varied patient population. The precautions taken by COI were effective in controlling the spread of the SARS-CoV-2 virus while returning to elective orthopaedic surgery. Furthermore, data collected before and after the onset of the COVID-19 pandemic indicated that program performance and quality improved.
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Affiliation(s)
- Swaroopa Vaidya
- Connecticut Orthopaedic Institute, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, USA
| | - Daniel Berluti
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Meriden, USA
| | - John F Irving
- Connecticut Orthopaedic Institute, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, USA
| | - Gerard Girasole
- Connecticut Orthopaedic Institute, St. Vincent's Medical Center, Hartford Healthcare, Bridgeport, USA
| | - John D McCallum
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Meriden, USA
| | - Leonard Kolstad
- Connecticut Orthopaedic Institute, MidState Medical Center, Hartford Healthcare, Meriden, USA
| | - Tara McLaughlin
- Department of Research Administration, Hartford Healthcare, Hartford, USA
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