Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls

Homer Yang; Geoff Dervin; Susan Madden; Ashraf Fayad; Paul Beaulé; Sylvain Gagné; Mary Lou Crossan; Kathryn Wheeler; Melody Afagh; Tinghua Zhang; Monica Taljaard

doi:10.2196/10169

Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls

JMIR Perioper Med. 2018 Nov 5;1(2):e10169. doi: 10.2196/10169.

Authors

Homer Yang¹, Geoff Dervin², Susan Madden³, Ashraf Fayad¹, Paul Beaulé², Sylvain Gagné⁴, Mary Lou Crossan⁴, Kathryn Wheeler⁴, Melody Afagh⁴, Tinghua Zhang⁵, Monica Taljaard^{5

6}

Affiliations

¹ Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London, ON, Canada.
² Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada.
³ Department of Nursing, The Ottawa Hospital, Ottawa, ON, Canada.
⁴ Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
⁵ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

PMID: 33401365
PMCID: PMC7728407
DOI: 10.2196/10169

Abstract

Background: A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements.

Objective: The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis.

Methods: After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2.

Results: A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group.

Conclusions: The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively.

Trial registration: ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P).

Keywords: continuity of care; cost reductions; length of stay; postoperative care; postoperative emergency department visit; postoperative home monitoring; postoperative readmissions.

©Homer Yang, Geoff Dervin, Susan Madden, Ashraf Fayad, Paul Beaulé, Sylvain Gagné, Mary Lou Crossan, Kathryn Wheeler, Melody Afagh, Tinghua Zhang, Monica Taljaard. Originally published in JMIR Perioperative Medicine (http://periop.jmir.org), 05.11.2018.

Associated data

ClinicalTrials.gov/NCT02143232