Perioperative Surgical Home Program Evaluation: Elective Total Joint Arthroplasty

To determine the impact of perioperative surgical home (PSH) optimization of adult patients undergoing elective total joint arthroplasty on length of stay (LOS) and discharge destination.

A retrospective observational study was conducted at an urban regional medical system located in the Pacific Northwest region of the United States.

A retrospective chart review was conducted for adult patients who underwent elective total joint arthroplasty between January 1, 2022 and June 30, 2022. A total of 285 participants were included, of which 133 were in the PSH program. LOS, discharge destination, incidence of postoperative anemia, blood transfusion, surgical site infections, and death were evaluated, comparing PSH program participants to those who received standard perioperative care.

Participants in the PSH program did not demonstrate any difference in LOS (P = .838) or discharge destination (P = .498). Additionally, there was no difference in postoperative anemia requiring blood transfusion or surgical site infections (P = .132). There were no associated postoperative deaths recorded. Age and COPD (P = .031) were significant factors in the likelihood of discharge to a skilled nursing facility. LOS was positively associated with operating room duration (P = .015), age (P < .001), and postoperative morphine equivalents (P < .001), while postanesthesia care unit morphine equivalents (P = .004) were negatively associated with LOS. PSH participants were more likely to visit the ER within 30 days of the procedure (P = .044).

Age and COPD diagnosis were predictive of discharge location, while age, operating room duration, postanesthesia care unit morphine equivalent, and postoperative morphine equivalent were associated with LOS in the overall population. However, the PSH program evaluated did not demonstrate an impact on LOS or discharge location. A larger sample size is required to determine the impact of PSH programs on reducing postoperative complications.