Factors That Influence Resource Utilization Following Primary Lower Extremity Total Joint Arthroplasty

In an effort to reduce unnecessary emergency department (ED) visits, we established a "Total Joint Hotline" (TJH) for patients undergoing primary total knee arthroplasty (TKA) or total hip arthroplasty. This 24-hour hotline was designed to give patients direct access to the adult reconstruction care team during the postoperative period. The purpose of this study was to determine which patient- and procedure-related factors drove utilization of the TJH.

We prospectively collected data on 372 patients who underwent primary unilateral total joint arthroplasty (Total Joint Arthroplasty)-either TKA (N = 243) or THA (N = 129)-at a single institution over a 6-month period in 2021 (Men: 141, Women: 231). At the preoperative clinic visit, each patient received a wristband with a Total Joint Hotline contact number answered by a member of the adult reconstruction care team. Patients were encouraged to call the hotline with any concerns, which were addressed by providing reassurance, arranging clinic follow-ups, or directing them to the emergency department. Among all patients, 51.6% utilized the TJH. Phone logs were recorded for demographics and comorbidity data. Statistical analysis consisted of univariable negative binomial regression with alpha set at 0.05 and a 95% confidence level.

Call frequency did not differ by age (P = 0.45), sex (P = 0.36), body mass index (P = 0.74), or smoking status (P = 0.75). The TKA patients made 2.1 more calls than THA patients [2.1 (1.5 to 2.9); P < 0.0001]. Patients who had fibromyalgia made 2.1 more calls [2.1 (1.1 to 3.9); P = 0.026]. Those who had depression (P = 0.047) or were on psychiatric medication (P = 0.047) made 1.4 and 1.6 more calls, respectively. Anxiety (x1.3, P = 0.11) and bipolar disorder (x2.4, P = 0.10) showed similar trends, though not statistically significant.

Our findings suggest that TKA patients, particularly those who had fibromyalgia, depression, or were on psychiatric medication, are more likely to use postoperative resources. This information can guide patient counseling, resource planning, and the development of preoperative optimization strategies.