Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital - PubMed (original) (raw)

Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital

Adam J Taylor et al. J Am Acad Orthop Surg Glob Res Rev. 2022.

Abstract

Introduction: Rapid recovery protocols (RRPs) for total joint arthroplasty (TJA) can reduce hospital length of stay (LOS) and improve patient care in select cohorts; however, there is limited literature regarding their utility in marginalized patient populations. This report aimed to evaluate the outcomes of an institutional RRP for TJA at a safety net hospital.

Methods: A retrospective review of 573 primary TJA patients was done, comparing the standard recovery protocol (n = 294) and RRP cohorts (n = 279). Measured outcomes included LOS, 90-day complications, revision surgeries, readmissions, and emergency department visits.

Results: The mean LOS reduced from 3.0 ± 3.1 days in the standard recovery protocol cohort to 1.6 ± 0.9 days in the RRP cohort (P < 0.001). The RRP cohort had significantly fewer 90-day complications (11.1% versus 21.4%, P = 0.005), readmissions (1.4% versus 5.8%, P = 0.007), and revision surgeries (1.4% versus 4.4%, P = 0.047).

Conclusion: A RRP for primary TJA can be successfully implemented at a safety net hospital with a shorter LOS and fewer acute adverse events. Such protocols require a coordinated, multidisciplinary effort with strict adherence to evidence-based practices to provide high-quality, value-based surgical health care to an underserved cohort.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.

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Figures

Figure 1

Figure 1

Flowchart illustrating the rapid recovery protocol. PCP = primary care physician, UTOX = urine toxicology screen, TXA = tranexamic acid, TKA = total knee arthroplasty, POD = postoperative day

Figure 2

Figure 2

Flowchart depicting the inclusion criteria and cohort distribution. TJA = total joint arthroplasty, SRP = standard recovery protocol, RRP = rapid recovery protocol, THA = total hip arthroplasty, TKA = total knee arthroplasty

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