Sofia Ahsanuddin1, Daniel J Snyder1, Hsin-Hui Huang1, Aakash Keswani1, Jashvant Poeran1,2, Calin S Moucha1. 1. Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 2. Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Abstract
Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.
Background: Surgical scheduling, specifically the day of the week on which surgery is performed, has been associated with various postoperative outcomes in patients undergoing lower extremity joint arthroplasty. Purpose: We sought to investigate surgical scheduling as a potential modifiable factor for patient quality metrics and related costs. Methods: In a retrospective prognostic study, all total knee and total hip arthroplasty (TKA/THA) cases that took place in 2017 to 2018 at a multihospital academic health system were queried. Patients were separated by the day of the week the surgery was performed, with Monday/Tuesday compared to Thursday/Friday. Outcomes included length of stay (LOS) (extended LOS defined as 3 days or longer), cost, and complications. Multivariable regression models measured associations between scheduling of surgery and outcomes; odds ratios (OR) and 95% confidence intervals (CIs) are reported. Results: Overall, 1,571 TKA and 992 THA patients were included (65% and 35%, respectively, performed on Monday/Tuesday and 70% and 30%, respectively, performed on Thursday/Friday). Patients undergoing TKA on Monday/Tuesday versus Thursday/Friday had higher American Society of Anesthesiologists scores (42% vs 33% with score of 3 or higher) but less often an extended LOS (31% vs 54%; adjusted OR: 2.76, 95% CI: 2.22-3.46), lower skilled nursing facility costs (unadjusted mean, $12,515 vs $14,154) and lower home health aide costs (unadjusted mean, $3,793 vs $4,192). Similar patterns were observed in THA patients. Conclusion: These results from institutional data suggest that surgical scheduling is a modifiable factor possibly associated with postoperative outcomes. Furthermore, more rigorous study is warranted.
Authors: Eric W Guo; Zain Sayeed; Muhammad T Padela; Mohsin Qazi; Mark Zekaj; Patrick Schaefer; Hussein F Darwiche Journal: Orthop Clin North Am Date: 2018-08-16 Impact factor: 2.472
Authors: Aakash Keswani; Christina Beck; Kristen M Meier; Adam Fields; Michael J Bronson; Calin S Moucha Journal: J Arthroplasty Date: 2016-07-09 Impact factor: 4.757
Authors: Hilal Maradit Kremers; Dirk R Larson; Cynthia S Crowson; Walter K Kremers; Raynard E Washington; Claudia A Steiner; William A Jiranek; Daniel J Berry Journal: J Bone Joint Surg Am Date: 2015-09-02 Impact factor: 5.284
Authors: Elena Losina; Rochelle P Walensky; Courtenay L Kessler; Parastu S Emrani; William M Reichmann; Elizabeth A Wright; Holly L Holt; Daniel H Solomon; Edward Yelin; A David Paltiel; Jeffrey N Katz Journal: Arch Intern Med Date: 2009-06-22
Authors: Larry E Miller; Melissa S Martinson; Joseph S Gondusky; Atul F Kamath; Friedrich Boettner; Samir K Bhattacharyya Journal: Clinicoecon Outcomes Res Date: 2019-02-07