Total Joint Replacement Perioperative Surgical Home Program: 2-Year Follow-Up.
Previously, our group successfully established one of the nation's first Perioperative Surgical Homes (PSHs) aimed at coordinating services to patients undergoing primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). As we now focus on extending the PSH to other service lines within the hospital, the long-term sustainability of this practice model is an important factor to consider moving forward.



We prospectively collected data from all patients who underwent elective primary TKA and THA at our institution between October 1, 2012, and September 30, 2014. Prospectively collected data included length of stay (LOS), 30-day readmission rate, postoperative pain scores, and complications.



During the 2-year period, there were 328 primary joint arthroplasty patients. Overall, the median LOS was significantly shorter in the second year of the PSH initiative (P = 0.03). Stratified by procedure, the median LOS for patients undergoing THA was significantly shorter in the second year (P = 0.02), whereas the median LOS for patients undergoing TKA did not differ between the 2 time periods. In the second year of the PSH initiative, significantly more patients were discharged home than to a skilled nursing facility compared with year 1 of the PSH initiative (P = 0.02). Readmission rates within 30 days after surgery to our institution were 0.9% (0.0-4.4) in the first year of the PSH initiative and 3.3% (confidence interval, 1.3%-7.2%) in the second year of the PSH initiative (P = not significant). Pain scores did not change significantly from year 1 to year 2 (P = not significant).



Data for the second year of implementation demonstrate similarly positive results in LOS, pain control, discharge destination, readmission, transfusion rates, and complications.
From the *Department of Anesthesiology and Perioperative Care, †Department of Orthopaedic Surgery, University of California Irvine, Irvine, California; and ‡Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
James
J
Cyriac
Leslie
L
Garson
Ran
R
Schwarzkopf
Kyle
K
Ahn
Joseph
J
Rinehart
Shermeen
S
Vakharia
Maxime
M
Cannesson
Zeev
Z
Kain
D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation; D001803:Blood Transfusion; D002140:California; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010351:Patient Discharge; D010359:Patient Readmission; D018802:Patient-Centered Care / Q000458:organization & administration; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D011446:Prospective Studies; D012307:Risk Factors; D012866:Skilled Nursing Facilities; D013997:Time Factors; D016896:Treatment Outcome