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ORTHOPEDICS: 30-day readmission rates for total hip and total knee replacement

The readmission rate for total hip replacement and total knee replacement procedures performed recently on patients in California, Florida and Massachusetts was studied.  Here are the findings for the percent of these patients readmitted within 30 days:

  • 4.29 percent (California during the period 2009 to 2011)
  • 4.7 percent (Florida during the period 2009 to 2013)
  • 3.92 percent (Massachusetts during the period 2009 to 2012)

The authors analyzed the role of infection in these 30-day readmissions, finding that in about one-third of the total hip and total knee arthroplasty patients, infection was listed as the primary or secondary reason for readmission.

Source: A retrospective study. Medicine, 96(38). Click here for free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617700/pdf/medi-96-e7961.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PERIOPERATIVE: Enhanced recovery after surgery

Enhanced recovery after surgery (ERAS) refers to redesigned perioperative care, sometimes also referred to as fast-track recovery after surgery.  Among the objectives are to reduce readmissions and avoid opioid abuse.  Changes include early ambulation, multi-modal analgesia and careful attention to nutrition.  The Cleveland Clinic includes ERAS in a list of the top 10 medical innovations for 2018.  The Gramlich article describes how the ERAS guidelines for colorectal surgery were implemented in six Canadian hospitals by the Alberta Health Services.  More information can also be obtained from the ERAS Society.

Sources:

Cleveland Clinic. Top 10 medical innovations.  Click here: http://innovations.clevelandclinic.org/Summit/Top-10-Medical-Innovations.aspx

Gramlich, L.M., and others. (2017). Implementation of enhanced recovery after surgery: A strategy to transform surgical care across a health system. Implementation Science. 12(67). Click here:  https://implementationscience.biomedcentral.com/track/pdf/10.1186/s13012-017-0597-5?site=implementationscience.biomedcentral.com

ERAS Society. Click here: http://erassociety.org/   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGERY: How much vascular surgery is done?

This is an analysis of over 3 million adult inpatient admissions in the state of Maryland during the years 2009 to 2013.

  • 3,157,499 adult admissions to Maryland hospitals 2009-2013
    •    154,004 (5 percent) of the total admissions involved a vascular procedure
      • 54 percent of the vascular procedures were emergent
      • 13 percent of the vascular procedures were urgent
      • 33 percent of the vascular procedures were elective

Patients who were in the emergent or urgent groups were found to have higher mortality rates and hospital resource utilization.

Source: Harris, D.G., and others. (2017, November). Defining the burden, scope, and future of vascular acute care surgery. Journal of Vascular Surgery, 66(5), 1511-1517.  Click here for access to the publisher’s website: http://www.jvascsurg.org/article/S0741-5214(17)31354-X/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: How much major surgery is infrequent? Is there an impact on costs?

Texas hospitals were studied to see how many inpatient major surgical procedures were not performed very often (once a month or less) at each hospital analyzed.  In this study of discharge data from 343 hospitals for the period late 2015 to early 2016, over half (54 percent)  of procedures were found to be uncommon (as defined above) for the hospital where they were performed.  These procedures accounted for 68 percent of inpatient costs.

Source: O’Neill, L. and others. (2017, September). Discharges with surgical procedures performed less often than once a month per hospital account for two-thirds of hospital costs of inpatient surgery. Journal of Clinical Anesthesia. 41, 99-103. Click here for publisher’s website: http://www.jcafulltextonline.com/article/S0952-8180(17)30659-1/fulltext   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BATRIATRICS: Is gastric bypass surgery effective?

The Roux-en-Y gastric bypass procedure was found to help obese patients lose and keep weight off 12 years after surgery compared to a group of similar patients who did not have surgery.  This study, out of Intermountain Healthcare and the University of Utah, found that patients who had the surgery lost weight and were able to keep it off compared with those who did not have surgery.  Additionally, half of the surgical patients who had type 2 diabetes at the time of surgery were in remission for diabetes 12 years later.

Source: Adams, T.D., and others. (2107, September 21). Weight and metabolic outcomes 12 years after gastric bypass. New England Journal of Medicine, 377(12), 1143-1155.  Click here for the publisher’s website: http://www.nejm.org/doi/full/10.1056/NEJMoa1700459  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ROBOTICS: Use in interventional cardiology procedures

…contemporary robot-assisted PCI systems improve operator safety by reducing ionizing radiation exposure and can improve procedural quality and outcomes by offering better accuracy accuracy in stent selection.”

The use of surgical robots for interventional cardiology procedures in the United States is discussed in this review prepared by physicians at the Mayo Clinic.  There is one manufacturer – Corindus Vascular Robotics – and two models.  The equipment is designed to help overcome a significant problem faced by interventional cardiologists, which is exposure to radiation and the need to wear leaded protective garments during procedures.  However, there are barriers which have slowed the adoption of this technology, such as a lack of randomized clinical trials and the price tag for the equipment.

Source: Maor, E., and others. (2017, July). Current and future use of robotic devices to perform percutaneous coronary interventions: A review. Journal of the American Heart Association. 6(7).  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586317/pdf/JAH3-6-e006239.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5586317/pdf/JAH3-6-e006239.pdf

SURGICAL SUITE: Implementing ERAS at Kaiser Permanente

Engagement among patients and clinicians is excellent, and the ERAS team is working toward realizing the vision of enhanced recovery hospitals where the ERAS paradigm becomes the standard of care for the 190,000 adult inpatients hospitalized in KPNC each year.”

How Kaiser Permanente Northern California implemented an Enhanced Recovery After Surgery (ERAS) project in 20 KPNC medical centers is described in this lengthy, scholarly article.  The initiative began with colon surgery patients, but success in reducing inpatient length of stay and post-op complication rates has led to expansion of the ERAS model to other surgical patients.  This article is well illustrated with graphics which will be helpful to other providers working through similar implementation projects, including a sample “My Calendar: Recover Safely and Quickly” intended for colon surgery patients.

Source: Liu, V.X., and others. (2017, Summer). The Kaiser Permanente Northern California enhanced recovery after surgery program: Design, development, and implementation. The Permanente Journal, 21(3), 53-61.  Click here: http://www.thepermanentejournal.org/issues/2017/summer/6477-the-kaiser-permanente-northern-california.html  Posted by AHA Resource Center (312) 422-2050, rc@aha.org