“Perioperative Surgical Home” Teams Improve Outcomes for TKA Patients

A team-based Perioperative Surgical Home (PSH) model helped reduce length of hospital stay and increase the chances of home rather than nursing-facility discharge for 405 total knee arthroplasty (TKA) patients, relative to 546 TKA patients who received usual care.

Although there were no significant differences in 30-day readmission rates between the two groups, average length of hospital stay for the PSH group was 1.9 days versus 3.2 days for the usual-care group. Only 6% of PSH patients went to a skilled nursing facility after hospital discharge, compared with 20% in the usual-care group. Using current cost structures, the Kaiser Permanente researchers estimated a total savings of $942,000, two-thirds from shorter hospital stays and a third from bypassing skilled nursing facilities.

The PSH teams were led by anesthesiologists, and the results were reported at the 2014 annual meeting of the American Society of Anesthesiologists. Preoperative medical optimization, an important aspect of this care model, began with appointments with anesthesiologists 3 to 14 days prior to scheduled surgery. The authors do not specifically cite orthopaedic surgeon involvement on these teams, but there’s every reason to believe surgeons did participate—and that surgeons could lead such teams.

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