Outcomes of an Institutional Rapid Recovery Protocol for Total Joint Arthroplasty at a Safety Net Hospital. (9th March 2022)

• Record Type: Journal Article
• Authors: Taylor, Adam J.; Kay, Robert D.; Bryman, Jason A.; Tye, Erik Y.; Longjohn, Donald B.; Najibi, Soheil; Runner, Robert P.
• Is Part Of: Journal of the AAOS. Volume 6:Number 3(2022)
• Publication Date: 2022-03-09
• Subjects: Orthopedic surgery -- Periodicals; 617.4705
• DOI: 10.5435/JAAOSGlobal-D-21-00173
• Languages: English
• ISSNs: 2474-7661

Abstract

Abstract : Introduction: Rapid recovery protocols (RRPs) for total joint arthroplasty (TJA) can reduce hospital length of stay (LOS) and improve patient care in select cohorts; however, there is limited literature regarding their utility in marginalized patient populations. This report aimed to evaluate the outcomes of an institutional RRP for TJA at a safety net hospital. Methods: A retrospective review of 573 primary TJA patients was done, comparing the standard recovery protocol (n = 294) and RRP cohorts (n = 279). Measured outcomes included LOS, 90-day complications, revision surgeries, readmissions, and emergency department visits. Results: The mean LOS reduced from 3.0 ± 3.1 days in the standard recovery protocol cohort to 1.6 ± 0.9 days in the RRP cohort ( P < 0.001). The RRP cohort had significantly fewer 90-day complications (11.1% versus 21.4%, P = 0.005), readmissions (1.4% versus 5.8%, P = 0.007), and revision surgeries (1.4% versus 4.4%, P = 0.047). Conclusion: A RRP for primary TJA can be successfully implemented at a safety net hospital with a shorter LOS and fewer acute adverse events. Such protocols require a coordinated, multidisciplinary effort with strict adherence to evidence-based practices to provide high-quality, value-based surgical health care to an underserved cohort.