Abstract
Outcome assessment is an integral part of joint replacement surgery in general and, undoubtedly, no less important in outpatient surgery. These metrics can be broadly divided into four main categories: patient-reported outcomes/satisfaction scores, safety/complications, readmissions, and healthcare costs. It is important to understand which metrics are currently reported to national databases and which metrics should be tracked primarily internally by one’s practice, hospital, and/or surgery center. Attention to outcomes metrics should assist the surgeon and institution in informing patient selection and perioperative protocols, mitigating risk, controlling costs, and improving outcomes. As public and private-payer models continue to evolve and mature, it will be critical to have robust systems in place to ensure that institutional data capture systems can seamlessly incorporate any future changes in outcomes metrics. While we do not expect any clinically meaningful changes in longer term joint-specific outcomes, costs of care and patient satisfaction may be improved when total joint arthroplasty surgeries are transitioned to the outpatient setting. It is our responsibility to ensure that the shift to outpatient care does not increase readmissions or complications.
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References
Kim H, Meath THA, Dobbertin K, Quiñones AR, Ibrahim SA, Mcconnell KJ. Association of the mandatory medicare bundled payment with joint replacement outcomes in hospitals with disadvantaged patients. JAMA Netw Open. 2019;2(11):1–13. https://doi.org/10.1001/jamanetworkopen.2019.14696.
Manickas-Hill O, Feeley T, Bozic KJ. A review of bundled payments in total joint replacement. JBJS Rev. 2019;7(11):e1. https://doi.org/10.2106/JBJS.RVW.18.00169.
Parcells BW, Giacobbe D, Macknet D, et al. Total joint arthroplasty in a stand-alone ambulatory surgical center: short-term outcomes. Orthopedics. 2016;39(4):223–8. https://doi.org/10.3928/01477447-20160419-06.
Shah RR, Cipparrone NE, Gordon AC, Raab DJ, Bresch JR, Shah NA. Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center. Arthroplast Today. 2018;4(4):484–7. https://doi.org/10.1016/j.artd.2018.08.002.
Halawi MJ, Jongbloed W, Baron S, Savoy L, Cote MP, Lieberman JR. Patient-reported outcome measures are not a valid proxy for patient satisfaction in total joint arthroplasty. J Arthroplast. 2019;35:3–7. https://doi.org/10.1016/j.arth.2019.09.033.
Scuderi GR, Bourne RB, Noble PC, Benjamin JB, Lonner JH, Scott WN. The new knee society knee scoring system. Clin Orthop Relat Res. 2012;470(1):3–19. https://doi.org/10.1007/s11999-011-2135-0.
Jung EK, Srivastava K, Abouljoud M, Keller R, Okoroha K, Davis J. Does hospital consumer assessment of healthcare providers and systems survey correlate with traditional metrics of patient satisfaction? The challenge of measuring patient pain control and satisfaction in total joint replacement. Arthroplast Today. 2018;4(4):470–4. https://doi.org/10.1016/j.artd.2018.02.009.
Kelly MP, Calkins TE, Culvern C, Kogan M, Della Valle CJ. Inpatient versus outpatient hip and knee arthroplasty: which has higher patient satisfaction? J Arthroplast. 2018;33(11):3402–6. https://doi.org/10.1016/j.arth.2018.07.025.
Healy WL, Della Valle CJ, Iorio R, et al. Complications of total knee arthroplasty: standardized list and definitions of the knee society. Clin Orthop Relat Res. 2013;471(1):215–20. https://doi.org/10.1007/s11999-012-2489-y.
Iorio R, Della Valle CJ, Healy WL, et al. Stratification of standardized TKA complications and adverse events: a brief communication. Clin Orthop Relat Res. 2014;472(1):194–205. https://doi.org/10.1007/s11999-013-2980-0.
Healy WL, Iorio R, Clair AJ, Pellegrini VD, Della Valle CJ, Berend KR. Complications of total hip arthroplasty: standardized list, definitions, and stratification developed by the hip society. Clin Orthop Relat Res. 2016;474(2):357–64. https://doi.org/10.1007/s11999-015-4341-7.
Public Policy Institute A. Insight on the issues impact of the medicare hospital readmission reduction program on hospital readmissions following joint replacement surgery. 2015.
Li BY, Urish KL, Jacobs BL, et al. Inaugural readmission penalties for total hip and total knee arthroplasty procedures under the hospital readmissions reduction program. JAMA Netw Open. 2019;2(11):e1916008. https://doi.org/10.1001/jamanetworkopen.2019.16008.
Cassard X, Garnault V, Corin B, Claverie D, Murgier J. Outpatient total knee arthroplasty: readmission and complication rates on day 30 in 61 patients. Orthop Traumatol Surg Res. 2018;104(7):967–70. https://doi.org/10.1016/j.otsr.2018.07.014.
Springer BD, Odum SM, Vegari DN, Mokris JG, Beaver WB. Impact of inpatient versus outpatient total joint arthroplasty on 30-day hospital readmission rates and unplanned episodes of care. Orthop Clin North Am. 2017;48(1):15–23. https://doi.org/10.1016/j.ocl.2016.08.002.
Ziemba-Davis M, Caccavallo P, Meneghini RM. Outpatient joint arthroplasty—patient selection: update on the outpatient arthroplasty risk assessment score. J Arthroplast. 2019;34(7):S40–3. https://doi.org/10.1016/j.arth.2019.01.007.
Levinson DR, General I. Medicare and beneficiaries could save billions if CMS reduces hospital outpatient department payment rates for ambulatory surgical center-approved procedures to ambulatory surgical center payment rates, A-05-12-00020. 2014. https://oig.hhs.gov/oas/reports/region5/51200020.pdf.
Piccinin MA, Sayeed Z, Kozlowski R, Bobba V, Knesek D, Frush T. Bundle payment for musculoskeletal care: current evidence (part 1). Orthop Clin North Am. 2018;49(2):135–46. https://doi.org/10.1016/j.ocl.2017.11.002.
Piccinin MA, Sayeed Z, Kozlowski R, Bobba V, Knesek D, Frush T. Bundle payment for musculoskeletal care: current evidence (part 2). Orthop Clin North Am. 2018;49(2):147–56. https://doi.org/10.1016/j.ocl.2017.11.003.
Palsis JA, Brehmer TS, Pellegrini VD, Drew JM, Sachs BL. The cost of joint replacement comparing two approaches to evaluating costs of total hip and knee arthroplasty. J Bone Jt Surg Am. 2018;100(4):326–33. https://doi.org/10.2106/JBJS.17.00161.
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Pivec, R., Lonner, J.H. (2023). Outcome Metrics: What to Measure Now and in the Future. In: Meneghini, R.M., Buller, L.T. (eds) Outpatient Hip and Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-031-27037-6_17
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