Patients In Tertiary Referral Center Research Articles

The effect of an orthopedic specialty hospital on operating room efficiency in shoulder arthroplasty

Operating room (OR) time is a major cost to the health care system. Therefore, increasing OR efficiency to save time may be a cost-saving tool. This study analyzed OR efficiency in shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC). All primary shoulder arthroplasties performed at our OSH and TRC were identified (2013-2015). Manually matched cohorts from the OSH and TRC were compared for OR times. Three times (minutes) were recorded: anesthesia preparation time (APT; patient in room to skin incision), surgical time (ST; skin incision to skin closed), conclusion time (CT; skin closed to patient out of room). There were 136 primary shoulder arthroplasties performed at the OSH and matched with 136 at the TRC. OSH and TRC patients were similar in age (P = .95), body mass index (P = .97), Charlson Comorbidity Index (P = 1.000), sex (P = 1.000), procedure (P = 1.000), insurance status (P = .714), discharge destination (P = .287), and diagnoses (P = .354). These matched populations had similar ST (OSH: 110.0 ± 26.6 minutes, TRC: 113.4 ± 28.7 minutes; P = .307). APT (39.2 ± 8.0 minutes) and CT (7.6 ± 3.8 minutes) were shorter in the OSH patients than APT (46.3 ± 8.8 minutes; P < .001) and CT (11.2 ± 4.7 minutes; P < .001) in TRC patients. Total nonoperative time (sum of APT and CT) at the OSH (46.8 ± 8.9 minutes) was shorter than at the TRC (57.5 ± 10.4 minutes; P < .001). Despite similar patient populations and case complexity, the OR efficiency at an OSH was superior to a TRC. Further analysis is needed to determine the financial implications of this superior OR efficiency.

Length of stay after shoulder arthroplasty—the effect of an orthopedic specialty hospital

One potential avenue for the realization of health care savings is reduction in hospital length of stay (LOS). Initiatives to reduce LOS may also reduce infection and improve patient satisfaction. We compare LOS after shoulder arthroplasty at an orthopedic specialty hospital (OSH) and a tertiary referral center (TRC). A single institutional database was used to retrospectively identify all primary shoulder arthroplasties performed between January 1, 2013, and July 1, 2015, at the OSH and TRC. Manually matched cohorts from the OSH and TRC were compared for LOS and readmission rate. There were 136 primary shoulder arthroplasties performed at the OSH matched with 136 at the TRC during the same study period. OSH and TRC patients were similar in age (P = .949), body mass index (P = .967), Charlson Comorbidity Index (P = 1.000), gender (both 52.21% male), procedure (69.12% total shoulder arthroplasty, 7.35% hemiarthroplasty, and 23.53% reverse shoulder arthroplasty), insurance status (P = .714), and discharge destination (P = .287). Despite equivalent patient characteristics, average LOS at the OSH was 1.31 ± 0.48 days compared with 1.85 ± 0.57 days at the TRC (t = 8.41, P < .0001). Of the 136 OSH patients, 3 (2.2%) required transfer to a TRC. Readmission rates for the OSH patients (2/136, 1.5%) and TRC patients (1/136, 0.7%) were similar (z = 0.585, P = .559). LOS at the OSH was significantly shorter than at the TRC for a strictly matched cohort of patients. This may be a result of fast-track rehabilitation and strict disposition protocols at the OSH. With rising shoulder arthroplasty demand, utilization of an OSH may be a safe avenue to delivery of more efficient and effective orthopedic care.