2023
Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement
Halperin S, Dhodapkar M, Radford Z, Li M, Rubin L, Grauer J. Total Knee Arthroplasty: Variables Affecting 90-day Overall Reimbursement. The Journal Of Arthroplasty 2023, 38: 2259-2263. PMID: 37279847, DOI: 10.1016/j.arth.2023.05.072.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAgedArthroplasty, Replacement, HipArthroplasty, Replacement, KneeHumansMedicaidMedicarePatient ReadmissionUnited StatesConceptsTotal knee arthroplastyTKA patientsPrimary total knee arthroplastyPostoperative emergency departmentPostoperative adverse eventsRisk of readmissionMultivariable linear regressionPerioperative periodPostoperative eventsAdverse eventsAppropriate patientsKnee osteoarthritisEmergency departmentPatients surgeryKnee arthroplastyOncologic indicationsCost-containment strategiesSurgical proceduresExclusion criteriaPatientsOptimize deliveryOverall reimbursementAdmissionReimbursementGreater increaseUrgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource
Dhodapkar M, Gouzoulis M, Halperin S, Radford Z, Rubin L, Grauer J. Urgent Care Visits Sought After Primary Total Hip Arthroplasty: A Potentially Overlooked Resource. The Journal Of Arthroplasty 2023, 38: 2361-2365. PMID: 37196730, DOI: 10.1016/j.arth.2023.05.012.Peer-Reviewed Original ResearchConceptsUrgent care visitsTotal hip arthroplastyPrimary total hip arthroplastyUrgent care utilizationCare visitsED utilizationCare utilizationUrgent careHip arthroplastyLess comorbidity burdenEmergency department visitsLarge national databaseLow-acuity diagnosesComorbidity burdenPostoperative EDED visitsDepartment visitsIndependent predictorsTHA patientsMultivariable analysisPostoperative weekUrgent evaluationSurgical sitePatient needsGreater incidence
2022
Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty
Galivanche A, Zhu J, Mercier M, McLean R, Wilhelm C, Varthi A, Grauer J, Rubin L. Admission NarxCare Narcotic Scores Are Associated With Increased Odds of Readmission and Prolonged Length of Hospital Stay After Primary Elective Total Knee Arthroplasty. JAAOS Global Research And Reviews 2022, 6: e22.00040. PMID: 36732305, PMCID: PMC9726283, DOI: 10.5435/jaaosglobal-d-22-00040.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, KneeHospitalizationHumansLength of StayNarcoticsPatient ReadmissionConceptsPrimary elective total knee arthroplastyElective total knee arthroplastyTotal knee arthroplastyNarcotic scoreOverall opioid usageAdverse eventsTKA patientsHospital stayKnee arthroplastyRisk of AEsOdds of readmissionPrimary TKA patientsPreoperative narcotic useTime of admissionDose-dependent increaseOpioid usagePostoperative outcomesPatient characteristicsProlonged lengthNarcotic useAdverse outcomesSingle institutionRevision surgeryReadmissionPatientsOutcomes Following Total Hip Arthroplasty in Patients With Postpolio Syndrome: A Matched Cohort Analysis
Mercier MR, Moore HG, Wolfstadt JI, Rubin LE, Grauer JN. Outcomes Following Total Hip Arthroplasty in Patients With Postpolio Syndrome: A Matched Cohort Analysis. The Journal Of Arthroplasty 2022, 37: 1822-1826. PMID: 35447277, DOI: 10.1016/j.arth.2022.04.016.Peer-Reviewed Original ResearchConceptsTotal hip arthroplastyPostpolio syndromeUrinary tract infectionPPS patientsControl patientsProsthetic dislocationTract infectionsRevision arthroplastyHip arthroplastyFive-year postoperative periodMatched Cohort AnalysisFive-year incidencePostoperative adverse eventsLong-term outcomesBasis of ageComorbidity burdenAdverse eventsPatient demographicsPostoperative periodPostoperative surveillanceHospital readmissionHip arthritisControl cohortAdministrative databasesCohort analysis
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 experienceLong-term Corticosteroid Use Independently Correlates With Complications After Posterior Lumbar Spine Surgery.
Kebaish KJ, Galivanche AR, Varthi AG, Ottesen TD, Rubin LE, Grauer JN. Long-term Corticosteroid Use Independently Correlates With Complications After Posterior Lumbar Spine Surgery. Orthopedics 2021, 44: 172-179. PMID: 34039214, DOI: 10.3928/01477447-20210416-01.Peer-Reviewed Original ResearchConceptsLong-term corticosteroid usePosterior lumbar spine surgeryPosterior lumbar surgeryLumbar spine surgeryPerioperative adverse outcomesCorticosteroid useAdverse eventsLumbar surgerySpine surgeryPropensity matchingAdverse outcomesNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseMinor adverse eventsEffect of immunosuppressionImprovement Program databaseLong-term corticosteroidsSerious adverse eventsBody mass indexMultiple surgical specialtiesAnesthesiologists classComparable patientsPerioperative outcomesSurgical factorsMore patientsA Matched Comparison of Postoperative Complications Between Smokers and Nonsmokers Following Open Reduction Internal Fixation of Distal Radius Fractures
Galivanche AR, FitzPatrick S, Dussik C, Malpani R, Nduaguba A, Varthi AG, Grauer JN. A Matched Comparison of Postoperative Complications Between Smokers and Nonsmokers Following Open Reduction Internal Fixation of Distal Radius Fractures. The Journal Of Hand Surgery 2021, 46: 1-9.e4. PMID: 33390240, DOI: 10.1016/j.jhsa.2020.09.020.Peer-Reviewed Original ResearchMeSH KeywordsDatabases, FactualHumansNon-SmokersPatient ReadmissionPostoperative ComplicationsRadius FracturesRetrospective StudiesRisk FactorsSmokersConceptsMinor adverse eventsDistal radius fracturesOpen reduction internal fixationSerious adverse eventsReduction internal fixationAdverse eventsRadius fracturesPropensity-score matchingInternal fixationSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseSTUDY/LEVELImprovement Program databasePerioperative adverse eventsMultivariable logistic analysisDemographic characteristicsSimilar demographic characteristicsHigh rateNonsmoker cohortPostoperative complicationsOperative treatmentPatient characteristicsSmoking groupComorbidity status
2020
Preoperative High, as well as Low, Platelet Counts Correlate With Adverse Outcomes After Elective Total Hip Arthroplasty
Malpani R, Bovonratwet P, Clark MG, Ottesen TD, Mercier MR, Grauer JN. Preoperative High, as well as Low, Platelet Counts Correlate With Adverse Outcomes After Elective Total Hip Arthroplasty. JAAOS Global Research And Reviews 2020, 4: e20.00049. PMID: 32890010, PMCID: PMC7470002, DOI: 10.5435/jaaosglobal-d-20-00049.Peer-Reviewed Original ResearchMeSH KeywordsArthroplasty, Replacement, HipElective Surgical ProceduresHumansLength of StayPatient ReadmissionPlatelet CountConceptsTotal hip arthroplastyNational Surgical Quality Improvement Program databaseQuality Improvement Program databasePreoperative platelet countAbnormal platelet countImprovement Program databasePlatelet countPerioperative complicationsAdverse eventsHospital readmissionTHA patientsAdverse outcomesProgram databaseHip arthroplastyElective primary total hip arthroplastyElective total hip arthroplastyPrimary total hip arthroplastyMulticenter patient populationPreoperative laboratory studiesMinor adverse eventsPostoperative adverse eventsLow platelet countPostoperative complication dataNormal platelet countHigher platelet countsReadmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients
Malpani R, John TS, Mercier MR, Ottesen TD, Nduaguba AM, Webb ML, Grauer JN. Readmissions After Distal Radius Fracture Open Reduction and Internal Fixation: An Analysis of 11,124 Patients. JAAOS Global Research And Reviews 2020, 4: e20.00110. PMID: 33969951, PMCID: PMC7384800, DOI: 10.5435/jaaosglobal-d-20-00110.Peer-Reviewed Original ResearchMeSH KeywordsAdultFracture Fixation, InternalHumansOpen Fracture ReductionPatient ReadmissionPostoperative ComplicationsRadiusUnited StatesConceptsNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseImprovement Program databaseMultivariate analysisAnesthesiologists classOpen reductionInternal fixationRisk factorsProgram databaseMedical reasonsSurgeons National Surgical Quality Improvement Program databasePredictors of readmissionInsulin-dependent diabetesCommon surgical procedureQuality improvement initiativesAmerican SocietyPostoperative readmissionsIndex surgeryInsulin usePerioperative factorsUnplanned readmissionPatient demographicsPerioperative outcomesAdult patientsSurgical reasonsCoagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty.
Malpani R, Mclynn RP, Bovonratwet P, Bagi PS, Yurter A, Mercier MR, Rubin LE, Grauer JN. Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty. Orthopedics 2020, 43: 233-238. PMID: 32674174, DOI: 10.3928/01477447-20200624-02.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overArthroplasty, Replacement, HipArthroplasty, Replacement, KneeBlood Coagulation DisordersDatabases, FactualFemaleHumansMaleMiddle AgedMultivariate AnalysisOutcome Assessment, Health CarePatient ReadmissionPostoperative ComplicationsRetrospective StudiesRisk FactorsYoung AdultConceptsHigher international normalized ratioInternational normalized ratioMajor adverse eventsTotal hip arthroplastyPartial thromboplastin timeHigher partial thromboplastin timeMinor adverse eventsAdverse eventsLow plateletsHematological conditionsSurgeons National Surgical Quality Improvement Program databaseNational Surgical Quality Improvement Program databaseTotal knee arthroplasty (TKA) populationQuality Improvement Program databasePrimary total hip arthroplastyDependent functional statusImprovement Program databasePostsurgical adverse eventsTotal knee arthroplastyMultiple adverse eventsPreoperative coagulopathyTHA cohortTKA groupTKA patientsHospital readmissionThirty-Day Readmissions After Aseptic Revision Total Hip Arthroplasty: Rates, Predictors, and Reasons Vary by Surgical Indication
Pathak N, Kahlenberg CA, Moore HG, Sculco PK, Grauer JN. Thirty-Day Readmissions After Aseptic Revision Total Hip Arthroplasty: Rates, Predictors, and Reasons Vary by Surgical Indication. The Journal Of Arthroplasty 2020, 35: 3673-3678. PMID: 32684401, DOI: 10.1016/j.arth.2020.06.069.Peer-Reviewed Original ResearchConceptsNational Surgical Quality Improvement ProgramThirty-day readmissionTotal hip arthroplastyRecurrent dislocationSurgical indicationsAseptic looseningPeriprosthetic fracturesPostoperative dislocationHip arthroplastyAseptic revision total hip arthroplastyMultivariate analysisPatients meeting inclusion criteriaSurgical Quality Improvement ProgramRevision total hip arthroplastyDifferent surgical indicationsPostoperative care pathwaysMeeting inclusion criteriaQuality Improvement ProgramFurther multivariate analysisAseptic indicationsFracture cohortPostoperative predictorsReadmission ratesReadmission riskCare pathwaySafety and Effectiveness of Antifibrinolytics in Posterior Scoliosis Surgery for Adolescent Idiopathic Scoliosis
Bovonratwet P, Sheha ED, Ondeck NT, Malpani R, Smith BG, Grauer JN. Safety and Effectiveness of Antifibrinolytics in Posterior Scoliosis Surgery for Adolescent Idiopathic Scoliosis. Clinical Spine Surgery A Spine Publication 2020, 33: e26-e32. PMID: 31162181, DOI: 10.1097/bsd.0000000000000836.Peer-Reviewed Original ResearchConceptsAdolescent idiopathic scoliosisPosterior spinal fusionMultilevel posterior spinal fusionIntensive care unitAntifibrinolytic useHospital lengthCare unitTreatment groupsIdiopathic scoliosisOperating roomEffectiveness of antifibrinolyticsNSQIP-Pediatric databasePediatric deformity surgeryPerioperative transfusion ratesVolume of transfusionLonger operative timePosterior scoliosis surgeryLarge national databaseTransfusion reductionPerioperative complicationsPostoperative complicationsTransfusion ratePostoperative outcomesPediatric patientsOperative time
2019
Abnormally High, as Well as Low, Preoperative Platelet Counts Correlate With Adverse Outcomes and Readmissions After Elective Total Knee Arthroplasty
Malpani R, Haynes MS, Clark MG, Galivanche AR, Bovonratwet P, Grauer JN. Abnormally High, as Well as Low, Preoperative Platelet Counts Correlate With Adverse Outcomes and Readmissions After Elective Total Knee Arthroplasty. The Journal Of Arthroplasty 2019, 34: 1670-1676. PMID: 31072745, DOI: 10.1016/j.arth.2019.04.012.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overAnemiaArthroplasty, Replacement, KneeDatabases, FactualDiabetes ComplicationsElective Surgical ProceduresFemaleHumansLength of StayMaleMiddle AgedPatient ReadmissionPlatelet CountPostoperative ComplicationsPostoperative PeriodPreoperative PeriodRetrospective StudiesThrombocytopeniaThrombocytosisTreatment OutcomeUnited StatesYoung AdultConceptsTotal knee arthroplastyElective total knee arthroplastyMinor adverse eventsPreoperative platelet countAbnormal platelet countLow platelet countPlatelet countHigher platelet countsAdverse eventsPostoperative complicationsTKA patientsAdverse outcomesKnee arthroplastyNational Surgical Quality Improvement Program databaseElective primary total knee arthroplastyMultivariate analysisQuality Improvement Program databasePrimary total knee arthroplastyMulticenter patient populationImprovement Program databasePostoperative adverse outcomesPlatelet count thresholdRetrospective comparative studyNormal platelet countLarger patient sample sizeCardiac Complications Related to Spine Surgery: Timing, Risk Factors, and Clinical Effect.
Bovonratwet P, Bohl DD, Malpani R, Haynes MS, Rubio DR, Ondeck NT, Shultz BN, Mahal AR, Grauer JN. Cardiac Complications Related to Spine Surgery: Timing, Risk Factors, and Clinical Effect. Journal Of The American Academy Of Orthopaedic Surgeons 2019, 27: 256-263. PMID: 30897607, DOI: 10.5435/jaaos-d-17-00650.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAgedAged, 80 and overDatabases, FactualFemaleHeart ArrestHumansIncidenceIntraoperative ComplicationsLength of StayMaleMiddle AgedMonitoring, PhysiologicMultivariate AnalysisMyocardial InfarctionOrthopedic ProceduresPatient ReadmissionPerioperative PeriodPostoperative ComplicationsRisk FactorsSpineTime FactorsYoung AdultConceptsCardiac complicationsSpine surgeryRisk factorsPostoperative periodNational Surgical Quality Improvement Program databaseSurgeons National Surgical Quality Improvement ProgramNational Surgical Quality Improvement ProgramQuality Improvement Program databaseSurgical Quality Improvement ProgramPerioperative cardiac complicationsHigh-risk patientsImprovement Program databaseInsulin-dependent diabetesLarge cohort studyQuality Improvement ProgramPreoperative anemiaPostoperative lengthCohort studyPerioperative periodPrimary outcomeClinical effectsCardiac arrestMyocardial infarctionProgram databaseAmerican CollegePediatric obesity is associated with short-term risks after pelvic osteotomy
Basques BA, Meadows MC, Grauer JN, Kogan M. Pediatric obesity is associated with short-term risks after pelvic osteotomy. Journal Of Pediatric Orthopaedics B 2019, 28: 95-99. PMID: 30234701, DOI: 10.1097/bpb.0000000000000552.Peer-Reviewed Original ResearchConceptsPelvic osteotomyRisk factorsNational Surgical Quality Improvement Program Pediatric databasePediatric pelvic osteotomiesRetrospective cohort studyIndependent risk factorLength of stayShort-term riskNonobese patientsPerioperative morbidityAdverse eventsCohort studyBlood transfusionOperative timePediatric obesityPatient counselingFemoral osteotomySurgical correctionPediatric databaseHip dysplasiaOsteotomyReadmissionObesityPatientsTransfusionChanges 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 PaymentsElective Total Shoulder Arthroplasty in Octogenarians: A Safe Procedure.
Bovonratwet P, Malpani R, Ondeck NT, Tyagi V, Grauer JN. Elective Total Shoulder Arthroplasty in Octogenarians: A Safe Procedure. Journal Of The American Academy Of Orthopaedic Surgeons 2019, 27: 145-154. PMID: 30252789, DOI: 10.5435/jaaos-d-17-00364.Peer-Reviewed Original ResearchConceptsPrimary total shoulder arthroplastyTotal shoulder arthroplastyNational Surgical Quality Improvement Program databaseQuality Improvement Program databaseImprovement Program databasePerioperative complicationsHospital stayProgram databaseShoulder arthroplastyElective total shoulder arthroplastyPropensity score-matched comparisonYoung populationRate of readmissionUrinary tract infectionPost-discharge careOctogenarian patientsPreoperative optimizationOctogenarian populationPerioperative coursePatient characteristicsTract infectionsSafe procedureRisk factorsOctogenariansReadmission
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 costsPatientsIncidence 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 ResearchMeSH KeywordsAgedFemaleHumansIncidenceLumbosacral RegionMaleMiddle AgedPatient DischargePatient ReadmissionPostoperative ComplicationsRisk FactorsSpinal FusionConceptsPosterior 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 study