The Journal of arthroplasty
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The Bundled Payment for Care Improvement (BPCI) Initiative is a Centers for Medicare and Medicaid Services program designed to promote coordinated and efficient care. This study seeks to report costs of readmissions within a 90-day episode of care for BPCI Initiative patients receiving total knee arthroplasty (TKA) or total hip arthroplasty (THA). ⋯ Hospital readmissions after THA and TKA are common and costly. Identifying the causes for readmission and assessing the cost will guide quality improvement efforts.
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Comparative Study
Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors.
It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA. ⋯ This multivariate regression analysis study showed that in patients undergoing primary TKA, postoperative pain was lower in males, older patients, and those treated with LBUP. Awareness of these factors may assist in developing patient-specific multimodal postoperative pain and education protocols that reduce opioid reliance and related adverse events.
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Kidney disease is associated with increased complications in total joint arthroplasty (TJA). The purpose of this study was to determine the association of kidney disease severity as measured by the chronic kidney disease (CKD) staging system with complications after TJA. ⋯ Severe CKD is associated with increased transfusion, length of stay, and in-hospital complications; and complications increased linearly with disease severity. Surgeons should be cognizant of this increase when evaluating TJA patients with renal disease.
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Comparative Study
Bilateral Simultaneous vs Staged Total Knee Arthroplasty: A Comparison of Complications and Mortality.
The purpose of this study was to compare the complications and mortality between bilateral simultaneous total knee arthroplasty (BTKA-Simultaneous) and bilateral staged TKA (BTK-Staged) while adjusting for differences in patient, surgeon, and hospital characteristics. ⋯ There is a lack of evidence to support superiority of either BTKA-Simultaneous or BTKA-Staged.
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The purpose of this study was to assess whether weaning of opioid use in the preoperative period improved total joint arthroplasty (TJA) outcomes. ⋯ Patients with a history of chronic opioid use who successfully decreased their use of opioids before surgery had substantially improved clinical outcomes that were comparable to patients who did not use opioids at all.