Joint Replacement: Risk Identification for Procedure Selection and Postsurgical Intervention

In their presentation last week at the American Academy of Orthopedic Surgeons Annual Meeting, investigators from the Perelman School of Medicine at the University of Pennsylvania announced the development of 2 new prediction tools aimed at identifying total hip and knee replacement patients who are at risk of developing serious complications after surgery. The first of these identifies surgical candidates with risk factors that should disqualify them from undergoing increasingly common outpatient or overnight procedures. The second seeks to refine the selection of patients who are routed to the intensive care unit postsurgery. The objective of both tools is to improve quality metrics and limit the incidence of readmission in an increasingly cost-conscious healthcare environment.

The predictive tools are based on studies of patients who underwent hip and knee replacement. The first uses a 6 point scale that surgeons can use to screen for risk factors that were shown to correlate to postsurgical complications. These candidates would be deemed inappropriate for same-day or short-stay procedures, in favor of traditional duration surgery and recovery. The second is a refinement of an older model that flagged preoperative risk factors such as history of chronic obstructive pulmonary disease, congestive heart failure, or coronary artery disease. A study found that less than 25% of these patients who were preemptively routed to the ICU required stepped-up intervention. By additionally screening for intraoperative factors, such as significant blood loss and the need for vasopressors during surgery, the tool sharpens the selection criteria for postsurgery admission to the ICU.

Read a news report about the new predictive tools here.

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