Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits After Total Joint Arthroplasty.

IF 4.3 1区医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2025-02-19 Epub Date: 2024-12-23 DOI:10.2106/JBJS.23.01157

Adriana P Liimakka, Alexander R Farid, Lillian Zhu, Patrick J Monette, Nathan H Varady, Jeffrey K Lange, Houman Javedan, Antonia F Chen

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Abstract

Background: Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.

Methods: This retrospective cohort study screened the medical records of patients ≥65 years of age undergoing primary elective TJA in a network of tertiary hospitals. Geriatrician consultations occurring within a period spanning 90 days before to 90 days after TJA were recorded. Bivariate analysis and multivariable regression models were used to assess the relationship between receiving these consultations and changes in the length of stay and ED visits.

Results: A total of 16,076 patients undergoing primary TJA were included. Of these surgical procedures, 9,677 (60.2%) were total knee arthroplasties and 6,087 (37.9%) were total hip arthroplasties; 1,416 (8.8%) of cases had geriatrician visits. Patients had lower odds of requiring postoperative ED visits when they had at least 1 geriatrician appointment within the week preceding an arthroplasty (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.68 to 0.99]; p = 0.005). This effect was most notable for 65-year-old patients (OR, 0.66 [95% CI, 0.45 to 0.98]).

Conclusion: This study reports promising evidence supporting the benefits of perioperative geriatrician visits on TJA outcomes. Preoperative visits were shown to be associated with decreased odds of ED visits after TJA in patients for up to 90 days postoperatively. Thus, geriatrician involvement in elective TJAs has the potential to improve outcomes and reduce morbidity and costs for patients and reduce costs for surgeons and institutions.

Level of evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

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围手术期老年专家评估与全关节置换术后急诊就诊风险降低相关

背景：先前的研究强调了老年专家咨询在改善髋部骨折修复的老年患者预后方面的益处，强调了增强的功能预后和降低的发病率。然而，老年人护理对选择性全关节置换术（TJA）患者预后的影响尚未得到描述。我们的目的是确定术前或术后老年医生参与是否与TJA后住院时间和急诊时间（ED）的差异有关。方法：本回顾性队列研究筛选了三级医院网络中年龄≥65岁的初级选择性TJA患者的医疗记录。记录了在TJA之前90天至之后90天内进行的老年病专家咨询。使用双变量分析和多变量回归模型来评估接受这些咨询与住院时间和急诊科就诊时间变化之间的关系。结果：共纳入16076例原发性TJA患者。在这些手术中，9677例（60.2%）为全膝关节置换术，6087例（37.9%）为全髋关节置换术；1416例（8.8%）病例就诊于老年科医生。如果患者在关节置换术前一周内至少有1次老年病医生预约，则患者术后需要急诊科就诊的几率较低(优势比[OR]， 0.97[95%可信区间（CI）， 0.68至0.99]；P = 0.005)。这种效应在65岁的患者中最为显著（OR, 0.66 [95% CI, 0.45 ~ 0.98]）。结论：本研究报告了有希望的证据，支持围手术期就诊对TJA预后的益处。术前就诊与TJA术后90天内患者ED就诊几率降低相关。因此，老年医生参与选择性TJAs有可能改善结果，降低患者的发病率和成本，降低外科医生和机构的成本。证据等级：治疗性III级。有关证据水平的完整描述，请参见作者说明。

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来源期刊

Journal of Bone and Joint Surgery, American Volume 医学-外科

CiteScore

8.90

自引率

7.50%

发文量

660

审稿时长

1 months

期刊介绍： The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.