Preoperative Risk Factor Screening Protocols in Total Joint Arthroplasty: A Systematic Review.
Background: Preoperative optimization protocols targeting potentially modifiable risk factors could prove beneficial in reducing the rate of complications in lower extremity total joint arthroplasty (LE-TJA). We aimed to summarize the evidence on preoperative screening protocols targeting modifiable...
| Publicado en: | Journal of Arthroplasty Vol. 35; no. 11; pp. 3353 - 3364 |
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| Autores principales: | , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Churchill Livingstone, Inc.
Nov2020
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=146413692&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 146413692 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08835403 1GFQ jtl: Journal of Arthroplasty issn: 08835403 maglogo: N pubinfo: dt: Nov2020 vid: 35 iid: 11 pid: 1242 pub: Churchill Livingstone, Inc. artinfo: ui: 146413692 146413692 NLM32600816 146413692 10.1016/j.arth.2020.05.074 NLM32600816 146413692 ppf: 3353 ppct: 11 formats: tig: atl: Preoperative Risk Factor Screening Protocols in Total Joint Arthroplasty: A Systematic Review. aug: au: Johns, William L. Layon, Daniel Golladay, Gregory J. Kates, Stephen L. Scott, Michael Patel, Nirav K. affil: Virginia Commonwealth University School of Medicine, Richmond, VA sug: subj: Arthroplasty, Replacement, Knee Adverse Effects Arthroplasty, Replacement, Hip Adverse Effects Risk Factors Postoperative Complications Length of Stay Prospective Studies Retrospective Design Human Systematic Review Meta Analysis ab: Background: Preoperative optimization protocols targeting potentially modifiable risk factors could prove beneficial in reducing the rate of complications in lower extremity total joint arthroplasty (LE-TJA). We aimed to summarize the evidence on preoperative screening protocols targeting modifiable risk factors to assess their effect on postoperative outcomes following primary LE-TJA.Methods: A literature search of MEDLINE, EMBASE, CINAHL, and Cochrane Library databases was performed in August 2019. The bibliographies of relevant publications were searched for further applicable studies. Included studies were required to report at least one outcome including prosthetic joint infection/surgical site infection (PJI/SSI), hospital length of stay (LOS), disposition, 90-day emergency department visits, or hospital readmissions after implementation of an evidence-based preoperative optimization protocol targeting modifiable risk factors. Methodological quality of included studies was assessed using the methodological index for non-randomized studies (MINORS) criteria.Results: A total of 8 retrospective cohort studies including 9915 patients were reviewed. Implementation of preoperative optimization protocols were associated with reductions in SSI (0.56% vs. 2.60%; RR 0.21 [95% CI 0.12 to 0.37]; P < .00001), hospital LOS, mean cost of care, and hospital readmission rates. The mean MINORS score for comparative studies was 16.285.Conclusions: Implementation and compliance with evidence-based preoperative protocols for optimization of modifiable risk factors is associated with overall improved outcomes following LE-TJA. SSI, hospital LOS, average total cost of care, and hospital readmission rates were favorable in those cohorts subjected to a preoperative intervention protocol. Future prospective studies are necessary for further refinement of preoperative optimization protocols and referral algorithms, without compromising patients' access to surgery.Level Of Evidence: III, Systematic Review. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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