overall compliance and any difference in compliance based on age or gender. Results: Compliance r... more overall compliance and any difference in compliance based on age or gender. Results: Compliance rates overall were: warfarin 87%, celecoxib 87%, mupirocin 84%, chlorhexidine 98%, shaving 91% and site marking 99%. Based on age sub-group analysis, there was no significant difference in compliance based on age or gender, and compliance did not fall below 82% in any category. Discussion: The currently used protocol of patient preoperative preparation achieves rates of compliance equivalent if not better to other studies. The lowest overall percentage of compliance was 84% in the mupirocin category. Therefore, the current regimen, while not perfect, is not inferior to other methods of improving patient compliance, and leaves a blueprint for other total joint arthroplasty surgeons to build off.
The {\it largest angle bisection} procedure is the operation which partitions a given triangle, $... more The {\it largest angle bisection} procedure is the operation which partitions a given triangle, $T$, into two smaller triangles by constructing the angle bisector of the largest angle of $T$. Applying the procedure to each of these two triangles produces a partition of $T$ into four smaller triangles. Continuing in this manner, after $n$ iterations, the initial triangle is divided into $2^n$ small triangles. We prove that as $n$ approaches infinity, the diameters of all these $2^n$ triangles tend to $0$, the smallest angle of all these triangles is bounded away from $0$, and that, with the exception of $T$ being an isosceles right triangle, the number of dissimilar triangles is unbounded.
Robotic-assisted technology was introduced into orthopedic procedures nearly two decades ago with... more Robotic-assisted technology was introduced into orthopedic procedures nearly two decades ago with the hope of reducing human error by improving mechanical alignment and joint kinematics. Four robotic systems are approved variably for use in the United States today as technologies for improving implant precision in total knee, total hip, unicompartmental knee, and patellofemoral arthroplasty procedures. Although evidence has strongly supported significant improvements in radiographic outcomes, the long-term clinical benefits and their associated economic implications are not well defined. Further complicating matters, institutions considering the implementation of robotic-assisted systems should anticipate other potential associated costs (e.g., capital investments, maintenance fees, disposable costs, and preoperative imaging requirements) specific to the different platforms. These costs can add a significant financial burden to the overall value of these procedures depending on the negotiated financial agreement, robotic life span, and institutional case volume. Therefore, in order to remain economically feasible, these costs must be offset by high case volumes and improvements in outcomes. Given the current performance-based healthcare environment, it is crucial that clinicians ensure that value-based goals are achieved.
The aim of this study is to report the rate and type of neurologic injury associated with flexion... more The aim of this study is to report the rate and type of neurologic injury associated with flexion supracondylar fractures at a tertiary, university institution treated over a 10-year period. All supracondylar humerus fracture cases treated at our institution between January 2004 and January 2014 were retrospectively reviewed. Twenty-three flexion-type fractures were identified. Patient demographics as well as fracture classification, treatment modalities, and pre-and post-treatment neurologic status were analyzed. Twenty-three flexion-type supracondylar humerus fractures were identified and reviewed out of a total of 1000 supracondylar humerus fractures (2.3%). Details of the patients’ neurologic status upon presentation demonstrated that 17 (74%) patients were intact and six (26%) patients presented with an ulnar neuropraxia. Zero type I fractures, one type II fractures (14.3%), and five type III fractures (33.3%) demonstrated an ulnar nerve palsy. Of these, all six nerve deficits resolved following treatment. One additional patient was identified with median nerve neuropraxia following treatment with closed reduction casting, which resolved following observation. A total of 4 (17.4%) patients were treated with closed reduction casting, 15 (65.2%) with closed reduction percutaneous pinning, and four (17.4%) with open reduction internal fixation. Flexion-type supracondylar fractures of the humerus are rare yet significant injuries. The 26% of patients who developed an ulnar neuropraxia following a displaced flexion supracondylar fracture were higher than previous studies reported in the literature. This increased prevalence may be due to the high rates of type III fractures reported in the current study. Level of evidence: III, Retrospective comparative cohort analysis.
Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) popula... more Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study—preoperative chronic opioid users and nonchronic opioid users. Opioid usage patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period. Fifty-four (16.0%) preoperative chronic opioid users were identified out of the total 338 patients included in the study. Preoperative chronic opioid users experienced significantly longer LOS (2....
BACKGROUND It is well recognized that unplanned readmissions following total joint arthroplasty (... more BACKGROUND It is well recognized that unplanned readmissions following total joint arthroplasty (TJA) are more prevalent in patients with comorbidities. However, few investigators have delayed surgery and medically optimized patients prior to surgery. In its current form, the Perioperative Orthopedic Surgical Home (POSH) is a surgeon-led screening and optimization initiative targeting 8 common modifiable comorbidities. METHODS A total of 4188 patients who underwent TJA between January 2014 and December 2016 were retrospectively screened by the Readmission Risk Assessment tool (RRAT) score. one thousand one hundred and ninety four subjects had a preoperative RRAT score ≥3 and were eligible for inclusion. Patients were then separated into 2 cohorts based on whether they were enrolled into the POSH initiative (POSH; n = 216) or continued with surgery (non-POSH; n = 978) despite their risk. RESULTS Since the implementation of the POSH initiative, patients with RRAT scores ranging from 3 to 5 have experienced lower 30-day (1.6% vs 5.3%, P = .03) and 90-day (3.2% vs 7.4%, P < .05) readmission rates when compared to the non-POSH cohort. Only 15.3% of medically optimized patients enrolled in the POSH initiative were discharged to a post-acute care facility, whereas 23.4% of non-POSH patients were discharged to a post-acute care facility (P = .01). There were no differences in length of stay and infection rates between the 2 cohorts. Moreover, 90-day episode-of-care costs were 14.9% greater among non-POSH Medicare TJA recipients and 32.6% higher if a readmission occurred. CONCLUSION The identification and medical optimization of comorbidities prior to surgical intervention may enhance the value of care TJA candidates receive. A standardized multidisciplinary approach to the medical optimization of high-risk TJA candidates may improve patient engagement and perioperative outcomes, while reducing cost associated with TJA. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.
Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally r... more Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The m...
BACKGROUND Interest in outpatient/same-day discharge (SDD) total hip arthroplasty (THA) has been ... more BACKGROUND Interest in outpatient/same-day discharge (SDD) total hip arthroplasty (THA) has been increasing over the last several years. There is considerable debate in the literature regarding the complication and readmission rates of these patients. To evaluate and validate the safety and efficacy of our institutional SDD THA care pathway, we compared the outcomes of patients undergoing SDD THA with patients who had a similar comorbidity profile and underwent inpatient THA. METHODS A retrospective review was conducted on 164 patients who underwent SDD THA from January 2015 to September 2016. The Risk of Readmission Tool, a validated risk stratification instrument, was applied to all inpatient THAs performed from June 2014 to December 2016. A cutoff Risk of Readmission Tool score < 3 was used to produce a cohort of 1858 inpatient THA patients, all of whom had a similar risk profile to patients who underwent SDD THA. Medicare patients were excluded from the inpatient THA cohort, which left a final inpatient sample of 1315 patients. Each cohort was evaluated for demographic variables, length of stay, 30-/90-day readmissions, and discharge disposition. RESULTS The SDD THA cohort had significantly lower body mass index (26.9 vs 28.2 kg/m2; PÂ = .002), had fewer minorities (89.6% vs 66.3% Caucasians; P < .001), was exclusively commercial insurance (100% vs 36.3%), had a shorter length of stay (0.37 vs 2.3 days, P < .001), and was exclusively discharged home (100% vs 92.6%). There was no statistically significant difference in 30-day readmission rates between either cohort (SDD 0.6% vs inpatient 1.6%; PÂ = .325). However, the SDD cohort had a significantly lower rate of 90-day readmissions than the inpatient cohort (0.6% vs 3.6%; PÂ = .014). CONCLUSION The use of an institutional SDD THA care pathway can produce results with equivalent or better short-term outcomes than that of traditional inpatient THA.
Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA) episode of ... more Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA) episode of care, and as a result, significant efforts are being made to minimize it. This study aims to assess the utility of the Outpatient Arthroplasty Risk Assessment (OARA) screening tool in accurately identifying patients for safe and early discharge after THA. A retrospective review was conducted on 332 consecutive patients who underwent primary THA at a single tertiary academic center. Patients were evaluated using the OARA score, a tool that has been proposed to identify patients who can safely undergo early discharge after THA. The validity of these claims was assessed by analyzing the OARA score's positive and negative predictive values for high vs low OARA scores between patients enrolled in our (1) same-day discharge (SDD) and 2) next-day discharge (NDD) pathways. When comparing the utility of the OARA score in accurately predicting length of stay, the OARA score demonstrated a (1) ...
The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthr... more The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had si...
The objective of this study was to evaluate the efficacy of respiratory synchronized compression ... more The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0.51 with NSIPCDs and 0.47 with RSCDs. This review demonstrates that RSCDs may be marginally more effective at preventing VTE events than NSIPCDs. Furthermore, the addition of mechanical prophylaxis to any chemoprophylactic regimen increases VTE prevention.
As the emphasis on value-based care within total joint arthroplasty increases, this procedure is ... more As the emphasis on value-based care within total joint arthroplasty increases, this procedure is becoming more prevalent in the outpatient setting. The goals of this study were to report on the authors' early experiences with same-day discharge and to identify patient characteristics that are associated with failure to discharge after total hip arthroplasty within this program. All patients who were enrolled in the same-day discharge total hip arthroplasty program at the study institution between January 2015 and July 2016 were included. Demographics, baseline characteristics, and clinical and quality outcomes were compared between patients who successfully completed this program and those who did not. Of the 163 study subjects, 143 (87.7%) were discharged successfully on the same day as surgery. Women, patients younger than 40 years, and patients older than 60 years all had an increased risk of failing the program. Body mass index of 26 kg/m2 or less was associated with a 40% g...
Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and m... more Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and mortality post-operatively. One of the treatments used to prevent such infections is chlorhexidine gluconate (CHG) baths prior to surgery. An obstacle to using CHG as a pre operative preventative measure to infection has been the low patient compliance rates. Our study aimed to analyze whether an educational class explaining the proper usage of CHG prior to the surgery date will improve patient compliance.Methods: We evaluated two different groups. One group consisted of patients who were scheduled for total joint arthroplasty (TJA) and attended an educational class in addition to receiving the standard preoperative protocol explaining the proper application of CHG. A second group consisted of subjects undergoing any other type of surgery but was not offered the additional educational class.Results: Subjects undergoing TJA had a higher compliance rate than all other surgeries (95.8% and 7...
overall compliance and any difference in compliance based on age or gender. Results: Compliance r... more overall compliance and any difference in compliance based on age or gender. Results: Compliance rates overall were: warfarin 87%, celecoxib 87%, mupirocin 84%, chlorhexidine 98%, shaving 91% and site marking 99%. Based on age sub-group analysis, there was no significant difference in compliance based on age or gender, and compliance did not fall below 82% in any category. Discussion: The currently used protocol of patient preoperative preparation achieves rates of compliance equivalent if not better to other studies. The lowest overall percentage of compliance was 84% in the mupirocin category. Therefore, the current regimen, while not perfect, is not inferior to other methods of improving patient compliance, and leaves a blueprint for other total joint arthroplasty surgeons to build off.
The {\it largest angle bisection} procedure is the operation which partitions a given triangle, $... more The {\it largest angle bisection} procedure is the operation which partitions a given triangle, $T$, into two smaller triangles by constructing the angle bisector of the largest angle of $T$. Applying the procedure to each of these two triangles produces a partition of $T$ into four smaller triangles. Continuing in this manner, after $n$ iterations, the initial triangle is divided into $2^n$ small triangles. We prove that as $n$ approaches infinity, the diameters of all these $2^n$ triangles tend to $0$, the smallest angle of all these triangles is bounded away from $0$, and that, with the exception of $T$ being an isosceles right triangle, the number of dissimilar triangles is unbounded.
Robotic-assisted technology was introduced into orthopedic procedures nearly two decades ago with... more Robotic-assisted technology was introduced into orthopedic procedures nearly two decades ago with the hope of reducing human error by improving mechanical alignment and joint kinematics. Four robotic systems are approved variably for use in the United States today as technologies for improving implant precision in total knee, total hip, unicompartmental knee, and patellofemoral arthroplasty procedures. Although evidence has strongly supported significant improvements in radiographic outcomes, the long-term clinical benefits and their associated economic implications are not well defined. Further complicating matters, institutions considering the implementation of robotic-assisted systems should anticipate other potential associated costs (e.g., capital investments, maintenance fees, disposable costs, and preoperative imaging requirements) specific to the different platforms. These costs can add a significant financial burden to the overall value of these procedures depending on the negotiated financial agreement, robotic life span, and institutional case volume. Therefore, in order to remain economically feasible, these costs must be offset by high case volumes and improvements in outcomes. Given the current performance-based healthcare environment, it is crucial that clinicians ensure that value-based goals are achieved.
The aim of this study is to report the rate and type of neurologic injury associated with flexion... more The aim of this study is to report the rate and type of neurologic injury associated with flexion supracondylar fractures at a tertiary, university institution treated over a 10-year period. All supracondylar humerus fracture cases treated at our institution between January 2004 and January 2014 were retrospectively reviewed. Twenty-three flexion-type fractures were identified. Patient demographics as well as fracture classification, treatment modalities, and pre-and post-treatment neurologic status were analyzed. Twenty-three flexion-type supracondylar humerus fractures were identified and reviewed out of a total of 1000 supracondylar humerus fractures (2.3%). Details of the patients’ neurologic status upon presentation demonstrated that 17 (74%) patients were intact and six (26%) patients presented with an ulnar neuropraxia. Zero type I fractures, one type II fractures (14.3%), and five type III fractures (33.3%) demonstrated an ulnar nerve palsy. Of these, all six nerve deficits resolved following treatment. One additional patient was identified with median nerve neuropraxia following treatment with closed reduction casting, which resolved following observation. A total of 4 (17.4%) patients were treated with closed reduction casting, 15 (65.2%) with closed reduction percutaneous pinning, and four (17.4%) with open reduction internal fixation. Flexion-type supracondylar fractures of the humerus are rare yet significant injuries. The 26% of patients who developed an ulnar neuropraxia following a displaced flexion supracondylar fracture were higher than previous studies reported in the literature. This increased prevalence may be due to the high rates of type III fractures reported in the current study. Level of evidence: III, Retrospective comparative cohort analysis.
Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) popula... more Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study—preoperative chronic opioid users and nonchronic opioid users. Opioid usage patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period. Fifty-four (16.0%) preoperative chronic opioid users were identified out of the total 338 patients included in the study. Preoperative chronic opioid users experienced significantly longer LOS (2....
BACKGROUND It is well recognized that unplanned readmissions following total joint arthroplasty (... more BACKGROUND It is well recognized that unplanned readmissions following total joint arthroplasty (TJA) are more prevalent in patients with comorbidities. However, few investigators have delayed surgery and medically optimized patients prior to surgery. In its current form, the Perioperative Orthopedic Surgical Home (POSH) is a surgeon-led screening and optimization initiative targeting 8 common modifiable comorbidities. METHODS A total of 4188 patients who underwent TJA between January 2014 and December 2016 were retrospectively screened by the Readmission Risk Assessment tool (RRAT) score. one thousand one hundred and ninety four subjects had a preoperative RRAT score ≥3 and were eligible for inclusion. Patients were then separated into 2 cohorts based on whether they were enrolled into the POSH initiative (POSH; n = 216) or continued with surgery (non-POSH; n = 978) despite their risk. RESULTS Since the implementation of the POSH initiative, patients with RRAT scores ranging from 3 to 5 have experienced lower 30-day (1.6% vs 5.3%, P = .03) and 90-day (3.2% vs 7.4%, P < .05) readmission rates when compared to the non-POSH cohort. Only 15.3% of medically optimized patients enrolled in the POSH initiative were discharged to a post-acute care facility, whereas 23.4% of non-POSH patients were discharged to a post-acute care facility (P = .01). There were no differences in length of stay and infection rates between the 2 cohorts. Moreover, 90-day episode-of-care costs were 14.9% greater among non-POSH Medicare TJA recipients and 32.6% higher if a readmission occurred. CONCLUSION The identification and medical optimization of comorbidities prior to surgical intervention may enhance the value of care TJA candidates receive. A standardized multidisciplinary approach to the medical optimization of high-risk TJA candidates may improve patient engagement and perioperative outcomes, while reducing cost associated with TJA. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.
Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally r... more Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The m...
BACKGROUND Interest in outpatient/same-day discharge (SDD) total hip arthroplasty (THA) has been ... more BACKGROUND Interest in outpatient/same-day discharge (SDD) total hip arthroplasty (THA) has been increasing over the last several years. There is considerable debate in the literature regarding the complication and readmission rates of these patients. To evaluate and validate the safety and efficacy of our institutional SDD THA care pathway, we compared the outcomes of patients undergoing SDD THA with patients who had a similar comorbidity profile and underwent inpatient THA. METHODS A retrospective review was conducted on 164 patients who underwent SDD THA from January 2015 to September 2016. The Risk of Readmission Tool, a validated risk stratification instrument, was applied to all inpatient THAs performed from June 2014 to December 2016. A cutoff Risk of Readmission Tool score < 3 was used to produce a cohort of 1858 inpatient THA patients, all of whom had a similar risk profile to patients who underwent SDD THA. Medicare patients were excluded from the inpatient THA cohort, which left a final inpatient sample of 1315 patients. Each cohort was evaluated for demographic variables, length of stay, 30-/90-day readmissions, and discharge disposition. RESULTS The SDD THA cohort had significantly lower body mass index (26.9 vs 28.2 kg/m2; PÂ = .002), had fewer minorities (89.6% vs 66.3% Caucasians; P < .001), was exclusively commercial insurance (100% vs 36.3%), had a shorter length of stay (0.37 vs 2.3 days, P < .001), and was exclusively discharged home (100% vs 92.6%). There was no statistically significant difference in 30-day readmission rates between either cohort (SDD 0.6% vs inpatient 1.6%; PÂ = .325). However, the SDD cohort had a significantly lower rate of 90-day readmissions than the inpatient cohort (0.6% vs 3.6%; PÂ = .014). CONCLUSION The use of an institutional SDD THA care pathway can produce results with equivalent or better short-term outcomes than that of traditional inpatient THA.
Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA) episode of ... more Hospital length of stay is a major driver of cost in the total hip arthroplasty (THA) episode of care, and as a result, significant efforts are being made to minimize it. This study aims to assess the utility of the Outpatient Arthroplasty Risk Assessment (OARA) screening tool in accurately identifying patients for safe and early discharge after THA. A retrospective review was conducted on 332 consecutive patients who underwent primary THA at a single tertiary academic center. Patients were evaluated using the OARA score, a tool that has been proposed to identify patients who can safely undergo early discharge after THA. The validity of these claims was assessed by analyzing the OARA score's positive and negative predictive values for high vs low OARA scores between patients enrolled in our (1) same-day discharge (SDD) and 2) next-day discharge (NDD) pathways. When comparing the utility of the OARA score in accurately predicting length of stay, the OARA score demonstrated a (1) ...
The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthr... more The advent of highly cross-linked polyethylene (HCLPE) has significantly improved total hip arthroplasty survivorship. HCLPE has been shown to improve wear properties in midterm outcomes when compared to traditional polyethylene liners; however, there is a paucity of studies evaluating long-term outcomes. In addition, there is concern that wear rates may accelerate as the implant ages. Thus, the aims of this study are to report on the longest-to-date follow-up of a specific first-generation HCLPE liner and to determine whether there is a change in the annual wear rate over time. Forty hips in 38 patients which were previously reported on in a midterm study were included in this long-term follow-up study. Patients in this cohort all received total hip arthroplasty between March 1999 and August 2004 using the Crossfire HCLPE liner. Annual wear rates (mm/y) were calculated for this cohort. Patients were contacted and asked about complications or revision procedures they may have had si...
The objective of this study was to evaluate the efficacy of respiratory synchronized compression ... more The objective of this study was to evaluate the efficacy of respiratory synchronized compression devices (RSCDs) versus nonsynchronized intermittent pneumatic compression devices (NSIPCDs) in preventing venous thromboembolism (VTE) after total joint arthroplasty. A systematic literature review was conducted. Data regarding surgical procedure, deep vein thrombosis, pulmonary embolism, mortality, and adverse events were abstracted. Compared with control groups, the risk ratio of deep vein thrombosis development was 0.51 with NSIPCDs and 0.47 with RSCDs. This review demonstrates that RSCDs may be marginally more effective at preventing VTE events than NSIPCDs. Furthermore, the addition of mechanical prophylaxis to any chemoprophylactic regimen increases VTE prevention.
As the emphasis on value-based care within total joint arthroplasty increases, this procedure is ... more As the emphasis on value-based care within total joint arthroplasty increases, this procedure is becoming more prevalent in the outpatient setting. The goals of this study were to report on the authors' early experiences with same-day discharge and to identify patient characteristics that are associated with failure to discharge after total hip arthroplasty within this program. All patients who were enrolled in the same-day discharge total hip arthroplasty program at the study institution between January 2015 and July 2016 were included. Demographics, baseline characteristics, and clinical and quality outcomes were compared between patients who successfully completed this program and those who did not. Of the 163 study subjects, 143 (87.7%) were discharged successfully on the same day as surgery. Women, patients younger than 40 years, and patients older than 60 years all had an increased risk of failing the program. Body mass index of 26 kg/m2 or less was associated with a 40% g...
Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and m... more Background: Surgical site infections (SSIs) continue to be a major contributor to morbidity and mortality post-operatively. One of the treatments used to prevent such infections is chlorhexidine gluconate (CHG) baths prior to surgery. An obstacle to using CHG as a pre operative preventative measure to infection has been the low patient compliance rates. Our study aimed to analyze whether an educational class explaining the proper usage of CHG prior to the surgery date will improve patient compliance.Methods: We evaluated two different groups. One group consisted of patients who were scheduled for total joint arthroplasty (TJA) and attended an educational class in addition to receiving the standard preoperative protocol explaining the proper application of CHG. A second group consisted of subjects undergoing any other type of surgery but was not offered the additional educational class.Results: Subjects undergoing TJA had a higher compliance rate than all other surgeries (95.8% and 7...
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