Reducing minor complications after joint-replacement surgery

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Reducing minor complications after joint-replacement surgery

Rheumawire

Jul 14, 2004

Mann

Rochester, MN - Patients undergoing elective hip and knee arthroplasty

had fewer minor complications when they were cared for postoperatively

by a comanagement team that included a hospitalist, a new study shows

[1]. However, there was no difference in either length of stay or costs

incurred when compared with patients who received standard postoperative

care from orthopedic surgeons with medical consultation.

The new study, published in the July 6, 2004 issue of the ls of

Internal Medicine, is the first study to evaluate the hospitalist model

in the care of elective orthopedic surgical populations. The randomized,

controlled trial involved 516 elderly patients (>75 years) having knee

or hip replacements. All patients received care at a single academic

medical center and were considered to be at high risk of postoperative

morbidity.

Dr Jeanne M Huddleston (Mayo Clinic College of Medicine, Rochester, MN)

and colleagues report that more patients in the group who were managed

by a hospitalist-orthopedic team were discharged from the hospital with

no complications, compared with their counterparts receiving standard

postoperative care (61.6% vs 49.8%, respectively). The hospitalist group

also suffered from fewer minor complications, such as fever,

urinary-tract infection, or abnormal blood-mineral (electrolyte) test

results (30.2% vs 44.3%, respectively).

However, both groups had similar rates (about 10%) of surgical

complications, including wound infection or blood in the joint, and

about 1% of patients in both groups had a major medical complication

such as heart attack or kidney failure, the researchers report.

Patients in both groups were discharged within 5 to 6 days after

surgery, and both groups had similar costs of care. However, when

adjusted for discharge delays, mean length of stay for patients in the

hospitalist model of care was shorter (5.1 days vs 5.6 days). Moreover,

nurses and surgeons preferred the comanagement model, while patients

were equally satisfied with both types of care.

Certain limitations exist within the new study. For example, it was not

blinded, and the study could not account for all costs related to the

hospitalist model, the researchers comment. They conclude that

additional research across diverse target populations and hospital

settings is needed.

In an editorial accompanying the new study [2], Dr Geno J Merli (

Jefferson University Hospital, Philadelphia, PA) says that the new study

" takes the first step in the development of a new approach to the

perioperative care of surgical patients by hospitalists. "

" Although the comanagement model had relatively small effects in this

study of a highly standardized surgical procedure, it may have a larger

effect on outcomes of care after surgical procedures that have a much

higher risk for serious postoperative complications and that can

increase length of stay, morbidity, and mortalityincluding fractured-hip

surgery, craniotomies, and abdominal pelvic surgery, " he comments.

Gazing into his crystal ball, he writes, " I believe the expansion of

hospitalist care is the direction of the future. The ultimate outcomes

will be reduced length of stay, fewer medical complications, and better

patient care. "

Sources

Huddleston JM, Long KH, Naessens JM, et al. Medical

and surgical comanagement after elective hip and knee arthroplasty: a

randomized, controlled trial. Ann Intern Med 2004; 141:28-38

Merli GJ. The hospitalist Joins the surgical team.

Ann Intern Med 2004; 141:67-69

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org