Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits After Total Joint Arthroplasty

Adriana P Liimakka; Alexander R Farid; Lillian Zhu; Patrick J Monette; Nathan H Varady; Jeffrey K Lange; Houman Javedan; Antonia F Chen

doi:10.2106/JBJS.23.01157

Perioperative Geriatrician Assessment Is Associated with a Lower Risk of Emergency Department Visits After Total Joint Arthroplasty

J Bone Joint Surg Am. 2024 Dec 23. doi: 10.2106/JBJS.23.01157. Online ahead of print.

Authors

Adriana P Liimakka^{1

2}, Alexander R Farid¹, Lillian Zhu¹, Patrick J Monette³, Nathan H Varady⁴, Jeffrey K Lange^{1

2}, Houman Javedan^{1

2

5}, Antonia F Chen^{1

6}

Affiliations

¹ Harvard Medical School, Boston, Massachusetts.
² Department of Orthopaedic Surgery, Brigham & Women's Hospital, Boston, Massachusetts.
³ Department of Anesthesiology, University of Virginia Medical Center, Charlottesville, Virginia.
⁴ Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
⁵ Division of Aging, Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
⁶ Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas.

PMID: 39715294
DOI: 10.2106/JBJS.23.01157

Abstract

Background: 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.

Methods: 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.

Results: 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]).

Conclusion: 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.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.