Canceled Total Joint Arthroplasty: Who, What, When, and Why?

被引:2
作者
Krueger, Chad A. [1 ]
Kozaily, Elie [1 ]
Gouda, Zane [2 ]
Chisari, Emanuele [1 ]
Courtney, P. Maxwell [1 ]
Austin, Matthew S. [1 ]
机构
[1] Rothman Inst, 925 Chestnut St, Philadelphia, PA 19107 USA
[2] Thomas Jefferson Univ Hosp, Sidney Kimmel Med Coll, Philadelphia, PA 19107 USA
关键词
canceled surgery; total knee arthroplasty; total hip arthroplasty; patient cancellation; delayed arthroplasty; PRIMARY TOTAL KNEE; MYOCARDIAL-INFARCTION; MEDICARE PATIENTS; CARDIAC-ARREST; RISK-FACTORS; TOTAL HIP; CANCELLATIONS; OUTCOMES; SURGERY; OPERATIONS;
D O I
10.1016/j.arth.2020.09.006
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Unexpected cancelation of scheduled total joint arthroplasty (TJA) procedures creates patient distress and disruption for the clinical team. The purpose of this study is to identify the etiology and fate of cancelations for scheduled TJAs. Methods: A consecutive series of 11,670 patients at a single institution from 2013 to 2017 was reviewed in March 2020. All patients who were scheduled for a primary total hip arthroplasty or total knee arthroplasty and subsequently canceled were identified. The etiology of cancelation and time to rescheduling were recorded. Results: Of the 505 (4.3%) canceled patients, 209 (42%) were due to medical reasons. Three hundred ninety-one patients (77%) eventually underwent their procedure at a mean delay of 165 days (19-1908). Only 53 (25%) patients canceled for a medical reason underwent further diagnostic or therapeutic intervention for their medical condition. When compared to patient-driven cancelations, those canceled for medical reasons had a higher mean Charlson Comorbidity Index (0.82 vs 0.39, P <.001), were canceled closer to the scheduled surgery date (8.55 vs 18.1 days, P <.001), and were more likely to eventually undergo surgery (86% vs 73%, P = .004). Conclusion: Canceled elective TJA surgeries are most often due to a medical concern, however only a minority of these patients undergo intervention for that medical condition. To minimize the risk of cancelation, healthcare providers may consider early referral of medically complex patients to the patient's primary care physician. After cancelation, patients should have a clearly defined path to return to the operative schedule to prevent further delays. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:857 / 862
页数:6
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