DeRogatis Michael J, Pellegrino Anna Ng, Wang Nigel, Higgins Margaret, Dubin Jeremy, Issack Paul, Sokunbi Gbolabo, Brogle Patrick, Konopitski Andrew
St. Luke's University Health Network, PPHP 2, 801 Ostrum Street, Bethlehem, PA, 18015, USA.
Rubin Institute for Advanced Orthopaedics, 2401 W Belvedere Ave 2nd Floor, Baltimore, MD, 21215, USA.
J Orthop. 2024 Jun 26;58:111-116. doi: 10.1016/j.jor.2024.06.028. eCollection 2024 Dec.
Outpatient total joint arthroplasty (TJA) is gaining popularity in the United States. With a shift towards value-based healthcare and bundled payment models, the importance of safe discharge after TJA is pertinent in reducing readmissions and subsequent cost of care. However, many acute issues or complications may not occur until after discharge which can result in emergency department visits and readmission. Our study aims to characterize the effect of remote monitoring devices on acute postoperative recovery in TJA discharged within 24 h. We hypothesized there would be a decreased readmission rate in the remote home monitoring cohort.
This prospective cohort compared 50 outpatient TJAs (primary total hip and total knee replacements) defined as discharged within 24 h with a remote home monitoring device to 50 outpatient TJAs who did not receive remote monitoring. Demographics, hospital length of stay, American Society of Anesthesiology scores, and Charlson Comorbidity Index were compared with no significant difference observed between cohorts (p > 0.05). Patients' vital signs were transmitted to a virtual response center for up to 48 h after discharge. An on-call medical team reviewed the transmissions and if prompted, would contact the patient to troubleshoot and triage. Primary outcome was 30-day hospital readmissions rates, while 30-day ED visits and patient satisfaction scores for the remote home monitoring were measured as secondary outcomes.
Within the remote monitoring cohort there was a 20 % incidence (10 patients) of abnormal vitals captured and 2 patients visited the ED, however there were no readmissions attributed to this group. Readmission rates and ED visits in the control non-monitored group were significantly higher at 12 % (p = 0.03), secondary to syncope, uncontrolled postoperative pain, cellulitis, hip dislocations, and postoperative fever. Of the patients who received remote monitoring, 14 % had trouble connecting the device to their smartphone, 44 % felt home monitoring helped in their care while recovering at home, 52 % made them feel safer, and 70 % would recommend this program.
Remote home monitoring with a virtual response team after outpatient TJA is a feasible way to mitigate readmissions in the acute postoperative period and increase patient satisfaction. Efforts to minimize costs should not be implemented at the expense of patients' health outcomes with a goal to find an appropriate balance between both agendas.
Therapeutic Level III.
门诊全关节置换术（TJA）在美国越来越受欢迎。随着向基于价值的医疗保健和捆绑支付模式的转变，TJA后安全出院对于减少再入院率和后续护理成本至关重要。然而，许多急性问题或并发症可能在出院后才会出现，这可能导致患者前往急诊科就诊和再次入院。我们的研究旨在描述远程监测设备对24小时内出院的TJA患者术后急性恢复的影响。我们假设远程家庭监测组的再入院率会降低。
这项前瞻性队列研究将50例使用远程家庭监测设备且在24小时内出院的门诊TJA患者（初次全髋关节置换和全膝关节置换）与50例未接受远程监测的门诊TJA患者进行了比较。对两组患者的人口统计学特征、住院时间、美国麻醉医师协会评分和Charlson合并症指数进行比较，发现两组之间无显著差异（p>0.05）。患者的生命体征在出院后最多48小时内传输到虚拟响应中心。值班医疗团队会查看传输数据，并在需要时联系患者进行故障排除和分诊。主要结局指标是30天内的医院再入院率，次要结局指标是30天内的急诊科就诊次数以及患者对远程家庭监测的满意度评分。
在远程监测组中，有20%（10例患者）的生命体征出现异常，有2例患者前往急诊科就诊，但该组患者均未再次入院。在未进行监测的对照组中，再入院率和急诊科就诊次数明显更高，为12%（p=0.03），原因是晕厥、术后疼痛控制不佳、蜂窝织炎、髋关节脱位和术后发热。在接受远程监测的患者中，14%的患者在将设备连接到智能手机时遇到困难，44%的患者认为家庭监测对其在家康复有帮助，52%的患者感觉更安全，70%的患者会推荐该项目。
门诊TJA后采用虚拟响应团队进行远程家庭监测是降低术后急性期再入院率并提高患者满意度的一种可行方法。不应以牺牲患者健康结局为代价来努力降低成本，目标是在这两个方面找到适当的平衡。
治疗性III级。
