Risk Stratification in Orthopaedic Surgery: An Important Adjustment for Value-Based Health Care and Quality...

Area of Science:

• Orthopaedic surgery
• Health policy
• Patient outcomes

Background:

• Risk stratification in orthopaedic surgery is complex, influenced by outcomes and patient factors.
• Current tools lack comprehensiveness for diverse orthopaedic procedures and patient populations.
• Effective risk stratification is crucial for patient safety, surgeon fairness, and resource allocation.

Purpose of the Study:

• To review the complexity and utility of risk stratification in orthopaedic surgery.
• To identify existing tools and their limitations for individual patient decision-making.
• To explore the role of risk stratification in population health and alternative payment models.

Main Methods:

• Literature review of risk stratification tools in orthopaedic surgery.
• Analysis of the application of risk stratification in individual patient care and population health.
• Evaluation of the impact of risk stratification on payment models and healthcare policy.

Main Results:

• No single comprehensive risk stratification tool exists for individual orthopaedic surgery decisions.
• The Elixhauser Comorbidity Measure and Risk Stratification Index 3.0 show promise.
• Population-level risk stratification can inform alternative payment models, preventing penalties for high-risk patients and avoiding cherry-picking.

Conclusions:

• Orthopaedic surgeons need awareness of available risk stratification tools, their strengths, and limitations.
• Risk stratification is essential for fair implementation of evolving payment models and public health policies.
• Careful consideration of unintended consequences is necessary when implementing risk stratification strategies.