title: Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial.
abstract: BACKGROUND
  Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown.
  
  
  OBJECTIVE
  To determine the impact of providing a collaborative, hospitalist-led model of care on postoperative outcomes and costs among patients having hip or knee arthroplasty.
  
  
  METHODS
  Randomized, controlled trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  526 patients having elective orthopedic surgery who are at elevated risk for postoperative morbidity.
  
  
  METHODS
  Length of stay, inpatient postoperative medical complications, health care provider satisfaction, and inpatient costs.
  
  
  METHODS
  A comanagement medical Hospitalist-Orthopedic Team compared with standard postoperative care by orthopedic surgeons with medical consultation.
  
  
  RESULTS
  More patients in the hospitalist group were discharged from the hospital with no complications (61.6% vs. 49.8%; difference, 11.8 percentage points [95% CI, 2.8 to 20.7 percentage points]). Fewer minor complications were observed among hospitalist patients (30.2% vs. 44.3%; difference, -14.1 percentage points [CI, -22.7 to -5.3 percentage points]). Observed length of stay was not statistically different between treatment groups. However, when adjusted for discharge delays, mean length of stay for patients in the hospitalist model of care was shorter (5.1 days vs. 5.6 days; difference, -0.5 day [CI, -0.8 to -0.1 day]). Total costs did not differ between groups. Orthopedic surgeons and nurses preferred the hospitalist model.
  
  
  CONCLUSIONS
  Care providers and patients were aware of intervention assignments, and the study could not capture all costs associated with the hospitalist model.
  
  
  CONCLUSIONS
  The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. huddleston.jeanne@mayo.edu
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Huddleston
authors.forename: Kirsten Hall
authors.initials: KH
authors.lastname: Long
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
authors.forename: David
authors.initials: D
authors.lastname: Vanness
authors.forename: Dirk
authors.initials: D
authors.lastname: Larson
authors.forename: Robert
authors.initials: R
authors.lastname: Trousdale
authors.forename: Matt
authors.initials: M
authors.lastname: Plevak
authors.forename: Miguel
authors.initials: M
authors.lastname: Cabanela
authors.forename: Duane
authors.initials: D
authors.lastname: Ilstrup
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wachter
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics / Q000592:standards; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000191:economics / Q000592:standards; D001291:Attitude of Health Personnel; D005260:Female; D017721:Hospital Costs; D020445:Hospitalists; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors