PT Achievement in Public Hospitals and Its Effect on Outcomes
Abstract
1. Introduction
2. Materials and Methods
2.1. Design and Study Population
2.2. Therapy Protocol
2.3. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
- Lau, E.; Mowat, F.; Kurtz, S.; Ong, K.; Halpern, M. Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from 2005 to 2030. J. Bone Jt. Surg.-Am. Vol. 2007, 89, 780. [Google Scholar]
- Daigle, M.E.; Weinstein, A.M.; Katz, J.N.; Losina, E. The cost-effectiveness of total joint arthroplasty: A systematic review of published literature. Best Pr. Res. Clin. Rheumatol. 2012, 26, 649–658. [Google Scholar] [CrossRef] [PubMed]
- Olthof, M.; Stevens, M.; Bulstra, S.K.; Akker-Scheek, I.V.D. The association between comorbidity and length of hospital stay and costs in total hip arthroplasty patients: A systematic review. J. Arthroplast. 2014, 29, 1009–1014. [Google Scholar] [CrossRef] [PubMed]
- Healy, W.L.; E Ayers, M.; Iorio, R.; A Patch, D.; Appleby, D.; Pfeifer, B.A. Impact of a clinical pathway and implant standardization on total hip arthroplasty: A clinical and economic study of short-term patient outcome. J. Arthroplast. 1998, 13, 266–276. [Google Scholar] [CrossRef]
- The Henry J Kaiser Family Foundation 2016. Hospital Adjusted Expenses per Inpatient Day|The Henry J. Kaiser Family Foundation n.d. Available online: https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D (accessed on 8 September 2019).
- El Bitar, Y.F.; Illingworth, K.D.; Scaife, S.L.; Horberg, J.V.; Saleh, K.J. Hospital Length of Stay following Primary Total Knee Arthroplasty: Data from the Nationwide Inpatient Sample Database. J. Arthroplast. 2015, 30, 1710–1715. [Google Scholar] [CrossRef] [PubMed]
- Johnson, R.L.; Kopp, S.L. Optimizing Perioperative Management of Total Joint Arthroplasty. Anesthesiol. Clin. 2014, 32, 865–880. [Google Scholar] [CrossRef] [PubMed]
- Kacik, A. Operating Margins Stabilize, But Not-for-Profit Hospitals Still Vulnerable. Mod. Heathcare 2019. Available online: https://www.modernhealthcare.com/providers/operating-margins-stabilize-not-profit-hospitals-still-vulnerable (accessed on 13 September 2019).
- Newman, J.M.; Szubski, C.R.; Barsoum, W.K.; Higuera, C.A.; Molloy, R.M.; Murray, T.G. Day of Surgery Affects Length of Stay and Charges in Primary Total Hip and Knee Arthroplasty. J. Arthroplast. 2017, 32, 11–15. [Google Scholar] [CrossRef]
- Barsoum, W.K.; Murray, T.G.; Klika, A.K.; Green, K.; Miniaci, S.L.; Wells, B.J.; Kattan, M.W. Predicting Patient Discharge Disposition After Total Joint Arthroplasty in the United States. J. Arthroplast. 2010, 25, 885–892. [Google Scholar] [CrossRef]
- Halawi, M.J.; Vovos, T.J.; Green, C.L.; Wellman, S.S.; Attarian, D.E.; Bolognesi, M.P. Preoperative Predictors of Extended Hospital Length of Stay Following Total Knee Arthroplasty. J. Arthroplast. 2015, 30, 361–364. [Google Scholar] [CrossRef]
- Dall, G.F.; Ohly, N.E.; Ballantyne, J.A.; Brenkel, I.J. The influence of pre-operative factors on the length of in-patient stay following primary total hip replacement for osteoarthritis: A multivariate analysis of 2302 patients. J. Bone Jt. Surg. Br. 2009, 91, 434–440. [Google Scholar] [CrossRef]
- Styron, J.F.; Koroukian, S.M.; Klika, A.K.; Barsoum, W.K. Patient vs. provider characteristics impacting hospital lengths of stay after total knee or hip arthroplasty. J. Arthroplast. 2011, 26, 1418–1426. [Google Scholar] [CrossRef] [PubMed]
- Muppavarapu, R.C.; Chaurasia, A.R.; Schwarzkopf, R.; Matzkin, E.G.; Cassidy, C.C.; Smith, E.L. Total Joint Arthroplasty Surgery: Does Day of Surgery Matter? J. Arthroplast. 2014, 29, 1943–1945. [Google Scholar] [CrossRef] [PubMed]
- Masaracchio, M.; Hanney, W.J.; Liu, X.; Kolber, M.; Kirker, K. Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS ONE 2017, 12, e0178295. [Google Scholar] [CrossRef] [PubMed]
- Teeny, S.M.; York, S.C.; Benson, C.; Perdue, S.T. Does Shortened Length of Hospital Stay Affect Total Knee Arthroplasty Rehabilitation Outcomes? J. Arthroplast. 2005, 20, 39–45. [Google Scholar] [CrossRef] [PubMed]
- Karim, A.; Pulido, L.; Incavo, S. Does Accelerated Physical Therapy After Elective Primary Hip and Knee Arthroplasty Facilitate Early Discharge? Am. J. Orthop. 2016, 45, E337–E342. [Google Scholar]
- Chen, A.F.; Stewart, M.K.; Heyl, A.E.; Klatt, B.A. Effect of Immediate Postoperative Physical Therapy on Length of Stay for Total Joint Arthroplasty Patients. J. Arthroplast. 2012, 27, 851–856. [Google Scholar] [CrossRef]
- Cademartiri, C.; Soncini, G. Total knee replacement. Postacute phase in rehabilitation: Objectives and strategies in postacute treatment. Acta bio-Medica Atenei Parm. 2004, 75, 56–62. [Google Scholar]
- Lowe, C.J.M.; Barker, K.L.; Dewey, M.; Sackley, C.M. Effectiveness of physiotherapy exercise after knee arthroplasty for osteoarthritis: Systematic review and meta-analysis of randomised controlled trials. BMJ 2007, 335, 812. [Google Scholar] [CrossRef]
- Labraca, N.S.; Castro-Sánchez, A.M.; Matarán-Peñarrocha, G.-A.; Arroyo-Morales, M.; Sanchez-Joya, M.D.M.; Moreno-Lorenzo, C. Benefits of starting rehabilitation within 24 hours of primary total knee arthroplasty: Randomized clinical trial. Clin. Rehabil. 2011, 25, 557–566. [Google Scholar] [CrossRef]
- Isaac, D.; Falode, T.; Liu, P.; I’Anson, H.; Dillow, K.; Gill, P. Accelerated rehabilitation after total knee replacement. Knee 2005, 12, 346–350. [Google Scholar] [CrossRef]
- den Hertog, A.; Gliesche, K.; Timm, J.; Mühlbauer, B.; Zebrowski, S. Pathway-controlled fast-track rehabilitation after total knee arthroplasty: A randomized prospective clinical study evaluating the recovery pattern, drug consumption, and length of stay. Arch. Orthop. Trauma Surg. 2012, 132, 1153–1163. [Google Scholar] [CrossRef]
- Bohl, D.D.; Li, J.; Calkins, T.E.; Darrith, B.; Edmiston, T.A.; Nam, D.; Gerlinger, T.L.; Levine, B.R.; Della Valle, C.J. Physical Therapy on Postoperative Day Zero Following Total Knee Arthroplasty: A Randomized, Controlled Trial of 394 Patients. J. Arthroplast. 2019, 34, S173–S177. [Google Scholar] [CrossRef] [PubMed]
- Sarpong, N.O.; Lakra, A.; Jennings, E.; Cooper, H.J.; Shah, R.P.; Geller, J.A. Same-Day Physical Therapy Following Total Knee Arthroplasty Leads to Improved Inpatient Physical Therapy Performance and Decreased Inpatient Opioid Consumption. J. Arthroplast. 2019. [Google Scholar] [CrossRef] [PubMed]
- Karlakki, S.L.; Hamad, A.K.; Whittall, C.; Graham, N.M.; Banerjee, R.D.; Kuiper, J.H. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Jt. Res. 2016, 5, 328–337. [Google Scholar] [CrossRef] [PubMed]
- Ponnusamy, K.E.; Naseer, Z.; El Dafrawy, M.H.; Okafor, L.; Alexander, C.; Sterling, R.S.; Khanuja, H.S.; Skolasky, R.L. Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty. J. Bone Jt. Surg.-Am. Vol. 2017, 99, e55. [Google Scholar] [CrossRef] [PubMed]
- Husted, H.; Holm, G.; Jacobsen, S. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: Fast-track experience in 712 patients. Acta Orthop. 2008, 79, 168–173. [Google Scholar] [CrossRef] [PubMed]
- Moses, M.J.; Novikov, D.; Anoushiravani, A.A.; Deshmukh, A.J.; Poultsides, L.; Crick, R.S.N.; Nieto, E.; Uzcategui, J.; Ochoa, L.; Thonon, E.; et al. The Role of Physical Therapy in Decreasing Length of Stay Following Total Knee Arthroplasty in a Public Hospital Setting. Int. J. Orthop. 2018, 5, 943–947. [Google Scholar] [CrossRef]
Illustrated Exercise Program Provided |
---|
Gastrocnemius stretching, ankle Pumps Quadriceps, Hamstring isometric stretching |
Active assist knee flexion and extension Supervised out of bed to chair transfers Supervised ambulation for 50 feet with assistive device |
Supervised stair negotiation 4-6 steps, step to step pattern Independent out of bed to chair transfers Modified independent ambulation for 100 feet with assistive device |
Variables | No Same-Day PT (n = 98) | Same-Day PT (n = 58) | p-Value ** |
---|---|---|---|
LOS | 3.97 (±2.66) | 2.05 (±1.09) | < 0.01 |
Age Group | 0.80 | ||
0–59 | 25 (25.5) | 15 (25.9) | |
60–64 | 21 (21.4) | 16 (27.6) | |
65–70 | 21 (21.4) | 12 (20.7) | |
71+ | 31 (31.6) | 15 (25.9) | |
Sex | 0.70 | ||
Male | 22 (22.4) | 15 (25.9) | |
Female | 76 (77.6) | 43 (74.1) | |
BMI | 0.76 | ||
Normal, <25 | 11 (11.2) | 8 (13.8) | |
Overweight 25–29.9 | 24 (24.5) | 16 (27.6) | |
Obese 30+ | 63 (64.3) | 34 (58.6) | |
ASA | 0.23 | ||
1 &2 | 86 (88.7) | 46 (80.7) | |
3 | 11 (11.3) | 11 (19.3) | |
Race | 0.33 | ||
Hispanic | 47 (49.0 | 29 (60.4) | |
White | 9 (9.4) | 3 (6.2) | |
Black | 28 (29.2) | 8 (16.7) | |
Asian | 12 (12.5) | 8 (16.7) |
Variables | IRR (95% CI) | p-Value |
---|---|---|
Same-Day PT | 0.54 (0.43, 0.68) | <0.01 |
Age Group | ||
0–59 (ref) | --- | --- |
60–64 | 1.09 (0.83, 1.45) | 0.52 |
65–70 | 1.04 (0.78, 1.39) | 0.79 |
71+ | 1.25 (0.97, 1.62) | 0.09 |
Sex | ||
Male (ref) | --- | --- |
Female | 1.38 (1.08, 1.77) | 0.01 |
BMI | ||
Normal, <25 (ref) | --- | --- |
Overweight 25–29.9 | 0.88 (0.63, 1.22) | 0.44 |
Obese 30+ | 1.05 (0.78, 1.43) | 0.74 |
ASA | ||
1 &2 (ref) | --- | --- |
3 | 0.99 (0.71, 1.37) | 0.95 |
Race | ||
Hispanic (ref) | --- | --- |
White | 1.29 (0.95, 1.77) | 0.11 |
Black | 0.98 (0.78, 1.23) | 0.85 |
Asian | 1.20 (0.90, 1.60) | 0.21 |
Variables | No Same-Day PT (n = 96) | Same-Day PT (n = 57) | p-Value |
---|---|---|---|
Disposition Status | 0.28612034 | ||
Subacute Rehab (SAR) | 18 (19) | 6 (11) | |
Skilled Nursing Facility (SNF) | 1 (1) | 0 (0) | |
Home | 77 (80) | 51 (89) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Morton, J.S.; Tang, A.; Moses, M.J.; Hamilton, D.; Crick, N.; Schwarzkopf, R. PT Achievement in Public Hospitals and Its Effect on Outcomes. Geriatrics 2019, 4, 58. https://doi.org/10.3390/geriatrics4040058
Morton JS, Tang A, Moses MJ, Hamilton D, Crick N, Schwarzkopf R. PT Achievement in Public Hospitals and Its Effect on Outcomes. Geriatrics. 2019; 4(4):58. https://doi.org/10.3390/geriatrics4040058
Chicago/Turabian StyleMorton, Jessica S., Alex Tang, Michael J. Moses, Dustin Hamilton, Neville Crick, and Ran Schwarzkopf. 2019. "PT Achievement in Public Hospitals and Its Effect on Outcomes" Geriatrics 4, no. 4: 58. https://doi.org/10.3390/geriatrics4040058
APA StyleMorton, J. S., Tang, A., Moses, M. J., Hamilton, D., Crick, N., & Schwarzkopf, R. (2019). PT Achievement in Public Hospitals and Its Effect on Outcomes. Geriatrics, 4(4), 58. https://doi.org/10.3390/geriatrics4040058