Abstract
Background:Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes.Methods:We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients’ demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded.Results:When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (p<0.05). However, when pre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes.Conclusion:From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.
Highlights
The volume of total joint arthroplasty procedures is increasing within the United States, as both the supply and demand have steadily climbed [1 - 3]
This study aims to determine whether the timing of pre-operative evaluations for patients undergoing total hip arthroplasty (THA) affects perioperative health outcomes
While this study found that pre-operative evaluations closer to the procedure date correlated with improved outcomes, as measured by length of stay (LOS), ICU admission frequency, and major complication frequency, it is important to note that this does not implicate a causal relationship due to the nature of this retrospective dataset
Summary
The volume of total joint arthroplasty procedures is increasing within the United States, as both the supply and demand have steadily climbed [1 - 3]. Total hip arthroplasty (THA) procedures are becoming a more. Lan and Kamath common orthopedic procedure [4, 5]. With this rise in procedure volume, it is important to understand the mechanisms by which procedure safety and quality can be improved [6]. Pre-operative medical evaluations are a crucial part of delivering robust, quality driven care for patients both within orthopedics and other fields of surgery [7 - 9]. The perioperative optimization of patients undergoing THA and revision procedures proves no exception [10]. As efficiency and throughput measures increase in importance in orthopedics, the ability to match pre-operative evaluation with the timing of surgery may prove important. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes
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