Liimakka Adriana P, Farid Alexander R, Zhu Lillian, Monette Patrick J, Varady Nathan H, Lange Jeffrey K, Javedan Houman, Chen Antonia F
Harvard Medical School, Boston, Massachusetts.
Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts.
J Bone Joint Surg Am. 2025 Feb 19;107(4):372-380. doi: 10.2106/JBJS.23.01157. Epub 2024 Dec 23.
Previous research has underscored the benefits of geriatrician consultation in improving outcomes for older patients undergoing hip fracture repair, highlighting enhanced functional outcomes and reduced morbidity. However, the impact of geriatrician care in outcomes for patients undergoing elective total joint arthroplasty (TJA) has yet to be described. We aimed to determine whether preoperative or postoperative geriatrician involvement was associated with differences in the length of hospital stay and emergency department (ED) visits after TJA.
This retrospective cohort study screened the medical records of patients ≥65 years of age undergoing primary elective TJA in a network of tertiary hospitals. Geriatrician consultations occurring within a period spanning 90 days before to 90 days after TJA were recorded. Bivariate analysis and multivariable regression models were used to assess the relationship between receiving these consultations and changes in the length of stay and ED visits.
A total of 16,076 patients undergoing primary TJA were included. Of these surgical procedures, 9,677 (60.2%) were total knee arthroplasties and 6,087 (37.9%) were total hip arthroplasties; 1,416 (8.8%) of cases had geriatrician visits. Patients had lower odds of requiring postoperative ED visits when they had at least 1 geriatrician appointment within the week preceding an arthroplasty (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.68 to 0.99]; p = 0.005). This effect was most notable for 65-year-old patients (OR, 0.66 [95% CI, 0.45 to 0.98]).
This study reports promising evidence supporting the benefits of perioperative geriatrician visits on TJA outcomes. Preoperative visits were shown to be associated with decreased odds of ED visits after TJA in patients for up to 90 days postoperatively. Thus, geriatrician involvement in elective TJAs has the potential to improve outcomes and reduce morbidity and costs for patients and reduce costs for surgeons and institutions.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
先前的研究强调了老年病医生会诊对于改善髋部骨折修复老年患者预后的益处，突出了功能改善和发病率降低。然而，老年病医生护理对接受择期全关节置换术（TJA）患者预后的影响尚未得到描述。我们旨在确定术前或术后老年病医生的参与是否与TJA后住院时间和急诊科（ED）就诊次数的差异相关。
这项回顾性队列研究筛查了三级医院网络中≥65岁接受初次择期TJA患者的病历。记录了TJA前90天至TJA后90天内发生的老年病医生会诊情况。采用双变量分析和多变量回归模型评估接受这些会诊与住院时间和ED就诊次数变化之间的关系。
共纳入16076例接受初次TJA的患者。在这些手术中，9677例（60.2%）为全膝关节置换术，6087例（37.9%）为全髋关节置换术；1416例（8.8%）病例有老年病医生会诊。在关节置换术前一周内至少有1次老年病医生预约的患者，术后需要到急诊科就诊的几率较低（比值比[OR]，0.97[95%置信区间（CI），0.68至0.99]；p = 0.005）。这种效应在65岁患者中最为显著（OR，0.66[95%CI，0.45至0.98]）。
本研究报告了支持围手术期老年病医生会诊对TJA预后有益的有前景的证据。术前会诊与TJA术后长达90天患者到急诊科就诊几率降低相关。因此，老年病医生参与择期TJA有可能改善患者预后、降低发病率和成本，并降低外科医生和医疗机构的成本。
治疗性三级证据。有关证据水平的完整描述，请参阅作者指南。
