The first is a six-point scale to help identify patients who should undergo the procedures in a hospital setting instead of an outpatient center, due to pre-existing risk factors such as chronic obstructive pulmonary disease, congestive heart failure, etc. Out of 1,012 patients who underwent primary total hip and knee replacement, researchers found 70 developed serious complications, most of which were cardiopulmonary in nature.
“Improved anesthesia and rehabilitation techniques have made outpatient and overnight stay for total hip and total knee replacements more common than ever,” said lead investigator P. Maxwell Courtney, MD, a fourth-year orthopedic surgery resident. “At the same time, pressures on hospitals to lower costs have led to an across-the-board emphasis on shortening or even eliminating in-hospital stays. While shorter stays are obviously a major overall benefit, we have to make sure that we identify patients who are at greater risk of complications and should thus not have their knee or hip replaced on an outpatient or overnight basis. Our tool provides this guidance.”
The second too is a weighted Penn Arthroplasty Risk Score to predict which patients should be sent to the ICU immediately following surgery. Doctors examines 738 patients undergoing total hip and knee replacement and found patients admitted to the ICU post-surgery were more likely to have a history of chronic obstructive pulmonary disease, congestive heart failure, etc.
“Under the previous model, nearly one in four patients undergoing knee or hip replacement were preemptively admitted to the ICU,” said Gwo-Chin Lee, MD, senior investigator on both studies. “However, we found that only 22 percent of these patients ultimately required such stepped-up intervention. This resulted in misuse of bed capacity and unnecessarily higher costs. By incorporating intraoperative factors, such as significant blood loss and the need for medicine to raise the patient’s blood pressure, we have refined the selection criteria for post-surgery admission to the ICU. This means fewer patients are routinely being admitted to these units after joint replacement surgery, resulting in lower overall costs without compromising patient safety as well as ensuring that relatively scarce critical care beds are available for those who truly need them.”
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