2021
Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty
Mercier MR, Galivanche AR, David WB, Malpani R, Pathak N, Hilibrand AS, Rubin LE, Grauer JN. Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty. PLOS ONE 2021, 16: e0257555. PMID: 34582475, PMCID: PMC8478166, DOI: 10.1371/journal.pone.0257555.Peer-Reviewed Original ResearchConceptsTotal knee arthroplastyPrimary total knee arthroplastyHospital Consumer AssessmentPostoperative outcomesPatient characteristicsHCAHPS survey resultsHCAHPS surveySurvey response rateKnee arthroplastyResponse rateHealthcare providersConsumer AssessmentHigher American SocietyMultivariate regression analysisAnesthesia scorePostoperative variablesTKA patientsAdult patientsPrimary outcomePatient factorsSurgical variablesPatient populationPatient satisfactionSingle institutionHospital experience
2020
Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty
Keswani AH, Snyder DJ, Ahn A, Austin DC, Jayakumar P, Grauer JN, Poeran J, Bozic KJ, Moschetti WE, Jevsevar DS, Galatz LM, Bronson MJ, Chen DD, Moucha CS. Metric Selection, Metric Targets, and Risk Adjustment Should be Considered in the Design of Gainsharing Models for Bundled Payment Programs in Total Joint Arthroplasty. The Journal Of Arthroplasty 2020, 36: 801-809. PMID: 33199096, DOI: 10.1016/j.arth.2020.10.007.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansPatient Care BundlesPatient DischargeRisk AdjustmentUnited StatesConceptsPatient-reported outcomesTotal joint arthroplastyRisk adjustmentJoint arthroplastyLength of stayUrban health systemSurgeon performanceBundled payment programsBundled payment modelReadmission ratesPRO collectionInclusion criteriaPatientsLevel IIIHealth systemArthroplastyPayment modelsAcceptable targetsPayment programsImportant mechanismAdjustmentTargetCharacteristics and Predictors of HCAHPS Nonresponse After Spine Surgery.
Malpani R, Adrados M, Mercier MR, McLynn RP, Galivanche AR, Pathak N, Grauer JN. Characteristics and Predictors of HCAHPS Nonresponse After Spine Surgery. Spine 2020, 45: e448-e456. PMID: 31609883, PMCID: PMC7113123, DOI: 10.1097/brs.0000000000003287.Peer-Reviewed Original ResearchConceptsSpine surgery patientsSpine surgeryHCAHPS surveyPerioperative outcomesAdverse eventsPatient characteristicsSurgery patientsSingle institutionMultivariate analysisLonger hospital lengthHigher American SocietyMajor adverse eventsMinor adverse eventsRetrospective cohort studyMinority of patientsPatient satisfaction surveyHospital Consumer AssessmentSatisfaction surveyNonresponder biasHospital lengthPatient demographicsCohort studyHospital readmissionRetrospective analysisBACKGROUND DATA
2019
Changes in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale?
Zogg CK, Falvey JR, Dimick JB, Haider AH, Davis KA, Grauer JN. Changes in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale? The Journal Of Arthroplasty 2019, 34: 1058-1065.e4. PMID: 30878508, PMCID: PMC6884960, DOI: 10.1016/j.arth.2019.01.068.Peer-Reviewed Original ResearchMeSH KeywordsAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeComputer SimulationDecision TreesElective Surgical ProceduresHumansMedicareMiddle AgedMonte Carlo MethodPatient DischargePatient Protection and Affordable Care ActPatient ReadmissionQuality of LifeRehabilitationReimbursement MechanismsSkilled Nursing FacilitiesUnited StatesConceptsExtent of therapyHealth-related qualityType of rehabilitationFunctional recoveryPatients' health-related qualitySkilled nursing facility useElective total hipPrimary TKA patientsOutcomes of patientsPatient-centered outcomesPatients' functional recoveryInpatient rehabilitation facilityNursing facility useEpisode of careAverage functional outcomeBundled payment programsDischarge dispositionTKA patientsUnplanned readmissionTotal hipFunctional outcomeAffordable Care ActOutcome measuresRehabilitation facilityBundled Payments
2018
Is Discharge Within a Day of Total Knee Arthroplasty Safe in the Octogenarian Population?
Bovonratwet P, Fu MC, Tyagi V, Gu A, Sculco PK, Grauer JN. Is Discharge Within a Day of Total Knee Arthroplasty Safe in the Octogenarian Population? The Journal Of Arthroplasty 2018, 34: 235-241. PMID: 30391051, DOI: 10.1016/j.arth.2018.10.005.Peer-Reviewed Original ResearchConceptsTotal knee arthroplastyNational Surgical Quality Improvement Program databaseQuality Improvement Program databasePrimary total knee arthroplastyImprovement Program databaseIndependent risk factorSerious adverse eventsAdverse eventsRisk factorsProgram databasePerioperative adverse eventsHospital lengthNonhome dischargeOctogenarian populationPerioperative complicationsElderly patientsOlder patientsPatient agePostdischarge careKnee arthroplastyPatient satisfactionProcedural characteristicsHigh riskHealthcare costsPatientsWhat Is the Adverse Event Profile After Prophylactic Treatment of Femoral Shaft or Distal Femur Metastases?
McLynn RP, Ondeck NT, Grauer JN, Lindskog DM. What Is the Adverse Event Profile After Prophylactic Treatment of Femoral Shaft or Distal Femur Metastases? Clinical Orthopaedics And Related Research® 2018, 476: 2381-2388. PMID: 30260860, PMCID: PMC6259894, DOI: 10.1097/corr.0000000000000489.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood TransfusionDatabases, FactualDiaphysesFemaleFemoral FracturesFemurFracture FixationFractures, SpontaneousHumansLength of StayLogistic ModelsMaleMiddle AgedMultivariate AnalysisNeoplasm MetastasisOdds RatioOperative TimePatient DischargePostoperative ComplicationsProspective StudiesRetrospective StudiesRisk FactorsTime FactorsTreatment OutcomeConceptsBody mass indexPathologic fractureAdverse eventsProphylactic treatment groupProphylactic treatmentBlood transfusionDisseminated cancerFemoral shaftComplication profileFracture groupFunctional outcomeProphylactic fixationDistal femurTreatment groupsNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseGreater body mass indexPerioperative complication profileProphylactic surgical stabilizationProphylactic surgical treatmentPostoperative adverse eventsAdverse event profileCurrent Procedural Terminology codesImprovement Program databaseMajor adverse eventsIncidence and considerations of 90-day readmissions following posterior lumbar fusion
Cui JJ, Gala RJ, Ondeck NT, McLynn RP, Bovonratwet P, Shultz B, Grauer JN. Incidence and considerations of 90-day readmissions following posterior lumbar fusion. The Spine Journal 2018, 19: 631-636. PMID: 30219360, DOI: 10.1016/j.spinee.2018.09.004.Peer-Reviewed Original ResearchConceptsPosterior lumbar fusionDays of dischargeReadmission ratesBaseline readmission ratesHuman Investigation CommitteeAdmission ratesDay readmissionLumbar fusionUtilization Project Nationwide Readmissions DatabaseAverage daily admission rateBaseline admission rateBundled payment plansNationwide Readmissions DatabaseHospital admission dataAverage admission rateDaily admission ratesCalendar yearCurrent quality metricsPLF patientsPatient demographicsPostoperative dayRetrospective studyPatient counselingPatient outcomesSpine surgeryDialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery
Ottesen TD, McLynn RP, Zogg CK, Shultz BN, Ondeck NT, Bovonratwet P, Bellamkonda KS, Rubin LE, Grauer JN. Dialysis is an independent risk factor for perioperative adverse events, readmission, reoperation, and mortality for patients undergoing elective spine surgery. The Spine Journal 2018, 18: 2033-2042. PMID: 30077772, DOI: 10.1016/j.spinee.2018.04.007.Peer-Reviewed Original ResearchConceptsElective spine surgeryNon-dialysis patientsDialysis-dependent patientsPerioperative adverse eventsAdverse eventsDialysis patientsSpine surgeryUnplanned readmissionCohort studyPatient demographicsRisk factorsNational Surgical Quality Improvement Program databaseRisk-adjusted multivariate regressionsQuality Improvement Program databaseOperating roomDialysis-independent patientsInstitutional cohort studyMinor adverse eventsRetrospective cohort studyElective spinal surgeryImprovement Program databaseIndependent risk factorMajor adverse eventsPercentage of complicationsAdministrative database studyDialysis Patients Undergoing Total Knee Arthroplasty Have Significantly Increased Odds of Perioperative Adverse Events Independent of Demographic and Comorbidity Factors
Ottesen TD, Zogg CK, Haynes MS, Malpani R, Bellamkonda KS, Grauer JN. Dialysis Patients Undergoing Total Knee Arthroplasty Have Significantly Increased Odds of Perioperative Adverse Events Independent of Demographic and Comorbidity Factors. The Journal Of Arthroplasty 2018, 33: 2827-2834. PMID: 29754981, DOI: 10.1016/j.arth.2018.04.012.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArthroplasty, Replacement, KneeComorbidityElective Surgical ProceduresFemaleHumansInpatientsLogistic ModelsMaleMiddle AgedMultivariate AnalysisOdds RatioPatient DischargePatient ReadmissionPostoperative ComplicationsQuality ImprovementRegression AnalysisRenal DialysisReoperationRetrospective StudiesRisk AssessmentConceptsTotal knee arthroplastyDialysis-dependent patientsAdverse eventsPatient demographicsDialysis patientsAdverse outcomesKnee arthroplastyNational Surgical Quality Improvement Program databaseOverall healthRisk-adjusted logistic regressionElective total knee arthroplastyQuality Improvement Program databaseImprovement Program databaseMinor adverse eventsNational inpatient databaseSevere adverse eventsBone health statusNondialysis cohortNondialysis patientsPerioperative periodTKA patientsAdult patientsPreoperative riskComorbidity factorsInstitutional cohortThe Rothman Index Is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients
McLynn RP, Ottesen TD, Ondeck NT, Cui JJ, Rubin LE, Grauer JN. The Rothman Index Is Associated With Postdischarge Adverse Events After Hip Fracture Surgery in Geriatric Patients. Clinical Orthopaedics And Related Research® 2018, 476: 997-1006. PMID: 29419631, PMCID: PMC5916609, DOI: 10.1007/s11999.0000000000000186.Peer-Reviewed Original ResearchConceptsRothman Index scoresPostdischarge adverse eventsHip fracture surgeryPostdischarge adverse outcomesAdverse eventsASA classRothman IndexHip fractureFracture surgeryIndex scoreGeriatric patientsAdverse outcomesMedical CenterOverall patient statusHip fracture careRoutine laboratory valuesMeasures of comorbidityRisk of complicationsBody mass indexAge 65 yearsPlan of careVulnerable patient populationCondition of patientsAcademic medical centerElectronic medical records
2017
What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?
Bohl DD, Ondeck NT, Basques BA, Levine BR, Grauer JN. What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty? Clinical Orthopaedics And Related Research® 2017, 475: 2952-2959. PMID: 28054326, PMCID: PMC5670043, DOI: 10.1007/s11999-016-5224-2.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeData MiningDatabases, FactualHumansLength of StayMiddle AgedMultivariate AnalysisPatient DischargePostoperative ComplicationsProcess Assessment, Health CareProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment OutcomeUnited StatesYoung AdultConceptsTotal joint arthroplastyAdverse eventsDays of diagnosisDeep vein thrombosisPulmonary embolismPostoperative dayVein thrombosisMyocardial infarctionJoint arthroplastySurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramMultivariate Cox proportional hazardsSurgical Quality Improvement ProgramMedian postoperative dayPulmonary embolism 3Postoperative adverse eventsSurgical site infectionMyocardial infarction 3Different adverse eventsRetrospective database analysisLife-threatening findingsCertain adverse eventsCox proportional hazardsSuch adverse eventsQuality Improvement ProgramThe Rothman Index as a predictor of postdischarge adverse events after elective spine surgery
McLynn RP, Ondeck NT, Cui JJ, Swanson DR, Shultz BN, Bovonratwet P, Grauer JN. The Rothman Index as a predictor of postdischarge adverse events after elective spine surgery. The Spine Journal 2017, 18: 1149-1156. PMID: 29155251, DOI: 10.1016/j.spinee.2017.11.008.Peer-Reviewed Original ResearchMeSH KeywordsAgedElective Surgical ProceduresFemaleHumansMaleMiddle AgedPatient DischargePatient ReadmissionPostoperative ComplicationsSpineConceptsElective spine surgeryPostdischarge adverse eventsMinor adverse eventsMajor adverse eventsAdverse eventsRothman IndexSpine surgeryMedical CenterOverall patient conditionRothman Index scoresHigh-risk patientsRate of readmissionRetrospective cohort studyLarge academic medical centerPostoperative day 30Body mass indexLength of stayAcademic medical centerPresent studyElectronic medical recordsLater scoresAnesthesiologists classHospital lengthPerioperative outcomesCohort studyDiscriminative Ability of Elixhauser's Comorbidity Measure is Superior to Other Comorbidity Scores for Inpatient Adverse Outcomes After Total Hip Arthroplasty
Ondeck NT, Bohl DD, Bovonratwet P, McLynn RP, Cui JJ, Grauer JN. Discriminative Ability of Elixhauser's Comorbidity Measure is Superior to Other Comorbidity Scores for Inpatient Adverse Outcomes After Total Hip Arthroplasty. The Journal Of Arthroplasty 2017, 33: 250-257. PMID: 28927567, DOI: 10.1016/j.arth.2017.08.032.Peer-Reviewed Original ResearchConceptsElixhauser comorbidity measuresCharlson Comorbidity IndexTotal hip arthroplastyAdverse outcomesComorbidity measuresComorbidity indexHip arthroplastyDiscriminative abilityBody mass indexNational Inpatient SampleLength of stayAdverse patient outcomesComorbidity scoreHospital stayPerioperative courseFrailty indexMass indexComplication measuresPatient's probabilityInpatient SamplePatient outcomesDemographic factors ageHigh riskOptimize outcomesAdmission centerIncidence, Risk Factors, and Impact of Clostridium difficile Colitis Following Primary Total Hip and Knee Arthroplasty
Bovonratwet P, Bohl DD, Malpani R, Nam D, Della Valle CJ, Grauer JN. Incidence, Risk Factors, and Impact of Clostridium difficile Colitis Following Primary Total Hip and Knee Arthroplasty. The Journal Of Arthroplasty 2017, 33: 205-210.e1. PMID: 28870746, DOI: 10.1016/j.arth.2017.08.004.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeClostridioides difficileColitisEnterocolitis, PseudomembranousFemaleHumansIncidenceKnee JointMaleMiddle AgedPatient DischargePostoperative ComplicationsQuality ImprovementRetrospective StudiesRisk FactorsUnited StatesConceptsNational Surgical Quality Improvement ProgramSurgical Quality Improvement ProgramDifficile colitisPrimary total hipRisk factorsQuality Improvement ProgramPrimary THATotal hipProcedural risk factorsClostridium difficile colitisHigh-risk patientsUrinary tract infectionInfectious risk factorsPoisson multivariate regressionPreoperative anemiaPerioperative antibioticsPostoperative periodTract infectionsPrimary outcomeSubstantial morbidityKnee arthroplastyColitisPatientsClinical implicationsHospital quality
2016
Is Outpatient Total Hip Arthroplasty Safe?
Nelson SJ, Webb ML, Lukasiewicz AM, Varthi AG, Samuel AM, Grauer JN. Is Outpatient Total Hip Arthroplasty Safe? The Journal Of Arthroplasty 2016, 32: 1439-1442. PMID: 28065622, DOI: 10.1016/j.arth.2016.11.053.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedArthroplasty, Replacement, HipBlood TransfusionDatabases, FactualFemaleHumansInpatientsLength of StayLogistic ModelsMaleMiddle AgedMultivariate AnalysisOutpatientsPatient DischargePatient ReadmissionPatient SafetyPoisson DistributionPostoperative ComplicationsPropensity ScoreQuality ImprovementRegression AnalysisRetrospective StudiesYoung AdultConceptsOutpatient total hip arthroplastyTotal hip arthroplastyAdverse eventsPropensity scoreSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseGeneral health outcome measuresDays adverse eventsImprovement Program databaseMultivariate Poisson regressionHealth outcome measuresHospital dischargePostoperative dayBlood transfusionExtended LOSTHA patientsPotential confoundersInpatient proceduresProgram databaseRelative riskHip arthroplastyOutcome measuresSafety dataStudy group
2012
Recovery Room Radiographs After Total Hip Arthroplasty Tradition vs Utility?
Ndu A, Jegede K, Bohl DD, Keggi K, Grauer JN. Recovery Room Radiographs After Total Hip Arthroplasty Tradition vs Utility? The Journal Of Arthroplasty 2012, 27: 1051-1056. PMID: 22305435, DOI: 10.1016/j.arth.2011.12.020.Peer-Reviewed Original Research