Dataset Information

Are Patient Outcomes Affected by Surgeon Experience With Total Hip Arthroplasty in Morbidly Obese Patients?

ABSTRACT:

Background

Surgeons with high volume (HV) of total hip arthroplasty (THA) have seen better outcomes than low volume (LV) surgeons. However, literature regarding surgeon volume and outcomes in morbidly obese THA patients is scarce. This study examines the association between surgeon volume with THA in morbidly obese patients (body mass index ≥40) and their clinical outcomes.

Methods

We retrospectively reviewed all morbidly obese patients who underwent primary THA at our institution between March 2012 and July 2020 with 2 years of follow-up. Clinical outcomes were compared between the HV (HVa, top quartile of surgeons with the highest overall yearly THA volume) and LV (LVa) surgeons. Similar analysis was run comparing HV of morbidly obese THA (HVo, top quartile of surgeons with the highest yearly morbidly obese THA volume) and LV of morbidly obese THA (LVo) surgeons.

Results

Six hundred and forty-three patients and 33 surgeons were included. HVa surgeons had significantly shorter length of stay and increased home discharge. HVa and HVo surgeons had significantly shorter operative times. There were no significant differences in overall 90-day major and minor complications or clinical differences in patient-reported outcomes. Revision rates and freedom from revisions did not differ between groups at 2-year follow-up.

Conclusions

HVa surgeons had significantly lower length of stay and operative times and increased discharge to home. There was no significant decrease in complications or revisions in either comparison model. Complications, revision rates, and patient satisfaction in morbidly obese patients who undergo THA may be independent of surgeon volume.

SUBMITTER: Rajahraman V

PROVIDER: S-EPMC10517274 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Are Patient Outcomes Affected by Surgeon Experience With Total Hip Arthroplasty in Morbidly Obese Patients?

Rajahraman Vinaya V Shichman Ittai I Berzolla Emily E Rozell Joshua J Meftah Morteza M Schwarzkopf Ran R

Arthroplasty today 20230919

<h4>Background</h4>Surgeons with high volume (HV) of total hip arthroplasty (THA) have seen better outcomes than low volume (LV) surgeons. However, literature regarding surgeon volume and outcomes in morbidly obese THA patients is scarce. This study examines the association between surgeon volume with THA in morbidly obese patients (body mass index ≥40) and their clinical outcomes.<h4>Methods</h4>We retrospectively reviewed all morbidly obese patients who underwent primary THA at our institution ...[more]

PMID: 37745952

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Project description:ObjectiveThis systematic review aims to summarise all the available evidence related to the association between pre-operative patient expectations (outcome expectations, process expectations and self efficacy expectations) and 5 different treatment outcomes (overall improvement, pain, function, stiffness and satisfaction) in patients with total knee or total hip arthroplasty at three different follow-op periods (>6 weeks; >6 weeks- ?6 months; >6 months).MethodsEnglish and Dutch language articles were identified through PubMed, EMBASE.com, PsycINFO, CINAHL and The Cochrane Library from inception to September 2012. Articles assessing the association between pre-operative patient expectations and treatment outcomes for TKA/THA in either adjusted or unadjusted analysis were included. Two reviewers, working independently, determined eligibility, rated methodological quality and extracted data on study design, population, expectation measurements, outcome measurements and strength of the associations. Methodological quality was rated by the same reviewers on a 19 item scale. The scores on the quality assessment were taken into account when drawing final conclusions.ResultsThe search strategy generated 2252 unique references, 18 articles met inclusion criteria. Scores on the methodological quality assessment ranged between 6% and 79%. Great variety was seen in definitions and measurement methods of expectations. No significant associations were found between patient expectations and overall improvement, satisfaction and stiffness. Both significant positive and non-significant associations were found for the association between expectations and pain and function.ConclusionsThere was no consistency in the association between patients' pre-operative expectations and treatment outcomes for TKA and THA indentified in this systematic review. There exists a need for a sound theoretical framework underlying the construct of 'patient expectations' and consistent use of valid measurement instruments to measure that construct in order to facilitate future research synthesis.

Project description:BackgroundRural patients have unique health-care factors influencing outcomes of arthroplasty, hypothetically putting these patients at increased risk for complications following total joint arthroplasty. The aim of this study is to better understand differences in patient outcomes and satisfaction between rural and urban patients receiving care in an urban setting and to provide more equitable care.MethodsA retrospective chart review was performed on patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020. Demographic, operative, and hospital outcomes were obtained from the institutional electronic medical record. Rurality was determined by rural-urban code (RUC) classifications by zip code with RUC codes 1-3 defined as urban and RUC 4-10 defined as rural.ResultsPatients from urban areas were more likely to visit the emergency department within 30 days postoperatively (P = .006) and be readmitted within 90 days (P < .001). However, unplanned (P < .001) admissions were higher in the rural group. There was no statistical difference in postoperative complications (P = .4). At 6 months, rural patients had higher patient-reported outcome measures (PROMs) including Hip Disability and Osteoarthritis Outcome Score total (P = .05), Hip Disability and Osteoarthritis Outcome Score interval (P = .05), self-reported functional improvement (P < .05), improvements in pain (P < .05), and that the surgery met expectations (P < .05). However, these values did not reach minimal clinically important difference.ConclusionsThere may be differences in emergency department visits, readmissions, and PROMs in rural vs urban populations undergoing total hip arthroplasty in an urban setting. Patient access to care and attitudes of rural patients toward health care may underlie these findings. Understanding differences in PROMs, satisfaction, and hospital-based outcomes based on rurality is essential to provide equitable arthroplasty care.

Project description:IntroductionThe purpose of this study is to evaluate the role of major psychiatric illness on patient outcomes after total joint arthroplasty.MethodsPatients with a diagnosis of a major psychiatric disorder undergoing total joint arthroplasty were retrospectively matched one-to-one with a cohort without such a diagnosis. Major psychiatric disorder in the registry was identified by diagnosis of anxiety, mood, or a psychotic disorder. Primary outcome of interest included perioperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included EuroQol-5D, adverse events, length of stay, 30-day readmission, and discharge destination.ResultsTotal number of patients were 1828. The total hip arthroplasty (37.80 ± 17.91, p = 0.023) and the total knee arthroplasty psychiatric group (43.38 ± 18.41, p = 0.050) had significantly lower pre-operative WOMAC scores. At 3 months, the total hip arthroplasty (76.74 ± 16.94, p = 0.036) and total knee arthroplasty psychiatric group (71.09 ± 18.64, p < 0.01) again had significantly lower 3-month post-operative WOMAC score compared to the control groups. However, outcomes at 1 year were difficult to interpret, as patients with major psychiatric conditions had an extremely high loss to follow-up. Compared to the control groups, the total hip arthroplasty and total knee arthroplasty psychiatric group had an increased length of stay by 1.43 days (p < 0.01) and 0.77 days, respectively (p = 0.05). Similarly, the psychiatric groups were discharged directly home less often (total hip arthroplasty 86.9%, p = 0.024 and total knee arthroplasty 87.6%, p = 0.022) than the control groups.ConclusionPatients with the diagnosis of a major psychiatric illness have an increased length of stay and are more likely to require a rehabilitation facility, compared to the control groups. Arguably, of utmost importance, there is a very high rate of loss to follow-up within the psychiatric groups. As such, we recommend these patients should be treated for their diagnosis prior to total joint arthroplasty. Furthermore, importance of clinical follow-up should be emphasized carefully.

Dataset Information

Are Patient Outcomes Affected by Surgeon Experience With Total Hip Arthroplasty in Morbidly Obese Patients?

Background

Methods

Results

Conclusions

Publications

Are Patient Outcomes Affected by Surgeon Experience With Total Hip Arthroplasty in Morbidly Obese Patients?

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