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Pre-Assessment Surgical Screening Clinics Provide a Safe and Equitable Alternative to Primary Care Evaluation in
Robert Carrier1, Jake Laverdiere2, Zachary T Grace3
1Connecticut Joint Replacement Institute, Hartford, Connecticut.
Background:
Preoperative medical clearance for total joint arthroplasty is valuable for identifying factors that could mitigate complication risks. Traditionally, preoperative clearance is obtained through a primary care provider (PCP). Literature has shown that Pre-Assessment Surgical Screening (PASS) clinics may enhance operating room efficiency, decrease surgical cancellations, reduce hospital costs, and improve patient care quality. The goal of this study was to compare 90-day surgical complication and cancellation rates between patients who received preoperative evaluation through a PASS clinic versus a PCP.
Methods:
This retrospective study included patients who underwent primary total joint arthroplasty from January 2017 through January 2024 at a single high-volume joint arthroplasty institute. There were 17,515 patients who met inclusion criteria; 52.3% (n = 9,164) were preoperatively evaluated by the PASS program and 47.7% (n = 8,351) by a PCP. Patient demographics, health characteristics, surgical cancellations, and 90-day complications were collected from patient charts. Outcomes were compared between patients who underwent PCP clearance versus PASS clearance utilizing univariate and logistic regression analyses.
Results:
On average, patients assessed by the PASS program were older (67 versus 66 years, P = 0.01), had a higher Charlson Comorbidity Index (P ≤ 0.01), and higher American Society of Anesthesiologists scores (P ≤ 0.01). Patients evaluated by a PCP were two times more likely to experience postoperative cardiac arrhythmia (odds ratio [OR]: 1.96; 95% confidence interval [CI]: 1.08 to 3.57; P = 0.03) and wound dehiscence (OR: 1.89; 95% CI: 1.04 to 3.45; P = 0.04). Patients evaluated by the PASS clinic were also 1.5 times more likely to experience periprosthetic joint infection (OR: 1.56; 95% CI: 1.08 to 2.25; P = 0.2). There was no significant difference in readmissions, total 90-day complications, or cancellations between the groups.
Conclusions:
Patients evaluated by the PASS clinic presented with more comorbidities than patients evaluated by a PCP. Despite these baseline differences, total complications, readmission, and cancellation rates did not significantly differ. Preoperative evaluation clinics can be a helpful resource for mitigating surgical cancellations, postoperative complications, and readmissions in high-risk patient groups.
