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Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up.

James Cyriac1, Leslie Garson, Ran Schwarzkopf

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The Perioperative Surgical Home (PSH) model improved length of stay for hip and knee replacement patients. This coordinated care approach demonstrated long-term sustainability and positive outcomes in its second year.

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Area of Science:

  • Healthcare Management
  • Surgical Outcomes
  • Patient Care Coordination

Background:

  • Established one of the nation's first Perioperative Surgical Homes (PSHs) for hip and knee arthroplasty.
  • Focusing on extending the PSH model to other surgical services requires evaluating long-term sustainability.

Purpose of the Study:

  • To assess the long-term sustainability and impact of the Perioperative Surgical Home (PSH) model.
  • To evaluate changes in patient outcomes between the first and second years of PSH implementation for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Main Methods:

  • Prospective data collection from elective primary TKA and THA patients over two years (Oct 2012 - Sep 2014).
  • Key metrics included length of stay (LOS), 30-day readmission rates, postoperative pain scores, and complication rates.

Main Results:

  • Overall median LOS significantly decreased in the second year of the PSH initiative (P = 0.03).
  • Median LOS for THA patients significantly shortened in year two (P = 0.02), but TKA LOS did not differ.
  • More patients were discharged home in year two compared to year one (P = 0.02); readmission rates and pain scores showed no significant changes.

Conclusions:

  • The second year of PSH implementation showed sustained positive results in LOS and discharge destination.
  • The PSH model demonstrates potential for long-term sustainability in coordinating joint arthroplasty care.