IMPACT OF A GERIATRIC CO-MANAGEMENT PROGRAM FOR ELECTIVE JOINT REPLACEMENT

Abstract

Background: Although geriatric fracture programs improve outcomes, only a small 2004 study showed a hospitalist co-management program to be effective after knee and hip arthroplasty in reducing minor medical complications. Our aim was to assess the impact of a geriatric joint co-management program (GJC) for elective joint replacement. Methods: We conducted a retrospective cohort study from Oct 2012-June 2013 in an academic community hospital of patients aged ≥ 70 who had elective knee and hip replacement with high post-operative risks. Geriatric co-management began post-op day 1 working collaboratively with the orthopedic team (surgeons, nursing, rehabilitation, and case managers). Geriatric syndromes were managed to prevent complications and facilitate discharge, and systems changes were implemented with the Joint Center team. Data were collected by the Joint Center program and included demographic data, outcomes, and surgical data. Using multivariate logistic and linear regression, patients in the GJC group were compared to a control group to assess differences in length of stay (LOS), readmissions (RaR), falls, disposition and in-hospital mortality. We controlled for age and American Society of Anesthesiologists (ASA) physical status. Results: Of 316 patients, 170 (54%) were in the GJC. Baseline demographic data were similar except for GJC patients were slightly younger and with lower ASA scores. The GJC had a significant decrease in LOS from 3.8 to 2.9 days (P=0.001) compared to those who did not receive the intervention. Discharges home and RaR trended lower in GJC but did not achieve statistical significance. No mortality was observed. Some patients in the control group who developed post-operative complications may have been seen by a Geriatrician potentially impacting control group outcomes. Geriatrician Participation in the monthly joint center meetings may have also resulted in some positive effects for the control group. Subjectively the Orthopedic Team is more comfortable in implementing prevention methods and managing common Geriatric Syndromes. Conclusion: A geriatric co-management program for elective knee and hip replacement is effective in reducing LOS. Further data collection may clarify if a decrease in RaR and increase in home discharge are significant.