Perioperative Surgical Home Program Evaluation: Elective Total Joint Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Healthcare Management

Background:

• Optimizing patient care pathways is crucial for improving outcomes in elective surgeries.
• The perioperative surgical home (PSH) model aims to streamline care and reduce costs.
• Total joint arthroplasty is a common procedure with significant implications for patient recovery and resource utilization.

Purpose of the Study:

• To evaluate the effect of a perioperative surgical home (PSH) optimization program on length of stay (LOS) and discharge destination in adult patients undergoing elective total joint arthroplasty.
• To compare postoperative outcomes, including complications, between patients in the PSH program and those receiving standard care.

Main Methods:

• A retrospective observational study was conducted on 285 adult patients undergoing elective total joint arthroplasty between January 2022 and June 2022.
• 133 patients were enrolled in the PSH program, while the remainder received standard perioperative care.
• Data collected included LOS, discharge destination, and incidence of postoperative anemia, blood transfusion, surgical site infections, and death.

Main Results:

• The PSH program did not show a significant difference in LOS (P = .838) or discharge destination (P = .498) compared to standard care.
• No significant differences were observed in postoperative anemia, blood transfusions, or surgical site infections (P = .132) between the groups.
• PSH participants had a higher likelihood of emergency room visits within 30 days (P = .044). Age and COPD were significant predictors of discharge to a skilled nursing facility.

Conclusions:

• Age and COPD diagnosis predict discharge location, while factors like operating room duration and opioid use are associated with LOS.
• The evaluated perioperative surgical home program did not demonstrate a significant impact on LOS or discharge destination for total joint arthroplasty patients.
• Larger sample sizes are necessary to definitively assess the impact of PSH programs on reducing postoperative complications and improving patient outcomes.