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3. Continuity of primary care and emergency department visits following knee and hip replacement surgery: a retrospective cohort study

Author

Lethbridge, Lynn, Richardson, C. Glen, and Dunbar, Michael J.

Subjects
Access control, Management, Complications and side effects, Patient outcomes, Company business management, Hospital emergency services -- Access control, Hip replacement arthroplasty -- Complications and side effects -- Patient outcomes, Health care disparities -- Management, Hospitals -- Emergency service
Abstract

Access to a primary care provider is an important indicator of quality health care. Continuity of primary care (CPC) has been identified as a central component of primary care provision [...], Background: Continuity of primary care (CPC) improves patient well-being, but the association between CPC and surgical outcomes has not been well studied. The numbers of joint replacement procedures are expected to rise considerably in the coming years, so it is crucial to identify factors related to successful outcomes. The purpose of this study was to examine the association between CPC and emergency department (ED) visits after knee and hip replacement surgery. Methods: Physician claims and hospital data from 2005 to 2020 in Nova Scotia were used in this retrospective study. To measure CPC, we used the Modified Modified Continuity Index (MMCI), which is the number of primary care providers adjusted for the total number of visits. The outcome was ED visits within 90 days of discharge. Logistic regression was used to test for associations between MMCI and the probability of an ED visit. Results: There were 28 574 knee and 16767 hip procedures in the data set; 13.9% (95% confidence interval [CI] 13.5%-14.3%) and 13.5% (95% CI 13.0%-14.0%) of the patients, respectively, had an ED visit within 90 days. For patients who underwent knee procedures, the mean MMCI was 0.868 (95% CI 0.867-0.870); 10.7% (95% CI 10.4%-11.1%) had perfect continuity of care. For patients who underwent hip procedures, the corresponding measures were 0.864 (95% CI 0.862-0.866) and 13.5% (95% CI 13.0%-14.0%). There was a statistically significant negative association between greater continuity of care and the probability of an ED visit after controlling for confounders. Conclusion: Having multiple primary care providers before surgery increased the likelihood of negative outcomes following knee or hip replacement surgery compared with having a single provider. Presurgical conversations should include primary care history to improve postsurgical outcomes. Contexte : La continuité des soins primaires améliore le bien-être des patients, mais le lien entre la continuité et l'issue des interventions chirurgicales n'a pas été bien étudié. On s'attend à ce que le nombre d'interventions pour prothèses articulaires augmente beaucoup d'ici les prochaines années. Il est donc crucial d'identifier les facteurs propices à une issue favorable. Le but de cette étude était d'analyser le lien entre la continuité des soins en médecine de soins primaires et les consultations dans les services d'urgence après une chirurgie pour prothèse de la hanche et du genou. Méthodes : Nous avons utilisé les données sur la rémunération des médecins et les données hospitalières de 2005 à 2020 en Nouvelle-?‰cosse pour cette étude rétrospective. Afin d'évaluer la continuité des soins, nous avons utilisé l'Indice de continuité modifié-modifié (ICMM), qui correspond au nombre de dispensateurs de soins primaires ajusté en fonction du nombre total de consultations. Le paramètre était les consultations au service des urgences dans les 90 jours suivant le congé. Nous avons appliqué la régression logistique pour tester les liens entre l'ICMM et la probabilité de consultations dans un service d'urgence. Résultats : L'ensemble de données comptait 28 574 interventions pour le genou et 16 767 pour la hanche; 13,9% (intervalle de confiance [IC] de 95% 13,5%-14,3%) et 13,5% (IC de 95% 13,0%-14,0%), respectivement, des malades ont consulté un service d'urgence dans les 90 jours. Pour les malades ayant reçu une prothèse du genou, l'ICMM moyen a été de 0,868 (IC de 95% 0,867-0,870); 10,7% (IC de 95% 10,4%-11,1%) ont bénéficié d'une parfaite continuité de soins. Pour les patients ayant reçu une prothèse de la hanche, les mesures correspondantes ont été de 0,864 (IC de 95% 0,862-0,866) et 13,5% (IC de 95% 13,0%-14,0%). On a observé un lien négatif statistiquement significatif entre une solide continuité des soins et les probabilités d'une consultation dans un service d'urgence, après la prise en compte des variables de confusion. Conclusion : Avoir consulté différents professionnels de la santé avant la chirurgie a accentué les risques d'une issue négative après une intervention pour prothèse du genou ou de la hanche, comparativement à n'en avoir consulté qu'un seul. Les discussions précédant l'intervention doivent inclure un historique des soins primaires pour améliorer les résultats postopératoires.

Published
2023
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8. Relationship Between Patient‐Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One‐Year Follow‐Up

Author

Hawker, Gillian A., Conner‐Spady, Barbara L., Bohm, Eric, Dunbar, Michael J., Jones, C. Allyson, Ravi, Bheeshma, Noseworthy, Tom, Woodhouse, Linda J., Faris, Peter, Dick, Donald, Powell, James, Paul, Paulose, Marshall, Deborah A., Hawker, Gillian A., Marshall, Deborah A., Bohm, Eric, Dunbar, Michael J., Faris, Peter, Jones, C. Allyson, Noseworthy, Tom, Ravi, Bheeshma, and Woodhouse, Linda

Published
2022
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25. Quantifying Achievable Levels of Improvement in Knee Joint Biomechanics During Gait After Total Knee Arthroplasty Relative to Osteoarthritis Severity.

Author

Outerleys, Jereme B., Dunbar, Michael J., Richardson, Glen, Hubley-Kozey, Cheryl L., and Astephen Wilson, Janie L.

Subjects
KNEE physiology, TOTAL knee replacement, GAIT in humans, MULTIVARIATE analysis, HEALTH outcome assessment, DISCRIMINANT analysis, PRE-tests & post-tests, OSTEOARTHRITIS, DIAGNOSIS, FACTOR analysis, BIOMECHANICS, LONGITUDINAL method
Abstract

Total knee arthroplasty (TKA) surgery improves knee joint kinematics and kinetics during gait for most patients, but a lack of evidence exists for the level and incidence of improvement that is achieved. The objective of this study was to quantify patient-specific improvements in knee biomechanics relative to osteoarthritis (OA) severity levels. Seventy-two patients underwent 3-dimensional (3D) gait analysis before and 1 year after TKA surgery, as well as 72 asymptomatic adults and 72 with moderate knee OA. A combination of principal component analysis and discriminant analyses were used to categorize knee joint biomechanics for patients before and after surgery relative to asymptomatic, moderate, and severe OA. Post-TKA, 63% were categorized with knee biomechanics consistent with moderate OA, 29% with severe OA, and 8% asymptomatic. The magnitude and pattern of the knee adduction moment and angle (frontal plane features) were the most significant contributors in discriminating between pre-TKA and post-TKA knee biomechanics. Standard of care TKA improves knee biomechanics during gait to levels most consistent with moderate knee OA and predominately targets frontal plane features. These results provide evidence for the level of improvement in knee biomechanics that can be expected following surgery and highlight the biomechanics most targeted by surgery. [ABSTRACT FROM AUTHOR]

Published
2021
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32. Quantifying uncertainties in biologically-based water quality assessment: A pan-European analysis of lake phytoplankton community metrics

Author

Thackeray, Stephen J., Nõges, Peeter, Dunbar, Michael J., Dudley, Bernard J., Skjelbred, Birger, Morabito, Giuseppe, Carvalho, Laurence, Phillips, Geoff, Mischke, Ute, Catalan, Jordi, de Hoyos, Caridad, Laplace, Christophe, Austoni, Martina, Padedda, Bachisio M., Maileht, Kairi, Pasztaleniec, Agnieszka, Järvinen, Marko, Solheim, Anne Lyche, and Clarke, Ralph T.

Published
2013
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42. Recommendations from the ICM-VTE: General

Author

Parvizi, Javad, Abbas, Azlina A., Abcha, Oussama, Abdelaal, Mohammad S., Ackermann, Paul W., Acuña, Alexander J., Ageno, Walter, Aguilar Ramírez, José J., Akkaya, Mustafa, Alameddine, Dana, Alfaro, David O., Alvand, Abtin, Alzeedi, Muadh, Andrade, Antonio J., Arnold, William V., Arish, Armin, Austin, Matthew S., Ay, Cihan, Azboy, Ibrahim, Babis, George C., Baker, Colin M., Barrack, Robert L., Barragán, Estuardo, Beatón-Comulada, David, Bedair, Hany S., Bell, Jennifer A., Beverland, David E., Bhatia, Nishant, Bialecki, Jerzy, Bondarenko, Stanislav, Bonilla, Guillermo, River Boschert, Salvador Oscar, Bracho, Carlos, Brooks, Dina, Buttaro, Martin, Cacan Daniel Caldeira, Mehmet A., Callaghan, John, Campbell, David G., Cancienne, Jourdan M., Cannegieter, Suzanne C., Canseco, Jose A., Caprini, Joseph A., Carrier, Marc, Castro Bejarano, Juan C., Catani, Fabio, Ceylan, Hasan Huseyin, Cha, Yong Han, Chan, Chee Ken, Chan, Noel, Cheung, Man Hong, Chisari, Emanuele, Cimminiello, Claudio, Citak, Mustafa, Colón-Miranda, Roberto G., Colwell, Clifford, Combs, Kristen, Cordeiro, Minal, Corvi, John J., Courtney Crispiana Cozowicz, P. Maxwell, Crawford, Ross W., Cruz, Eugénia, D'Amore, Taylor, Dantas, Pedro, Della Valle, Alejandro Gonzalez, Deltour, Charles, Demanes, Augustus C., Djaja, Yoshi P., Dunbar, Michael J., Egoavil, Miguel S., Egol, Kenneth A., Eichinger, Sabine, Elías, Luis F., Emmerson, Benjamin R., Ettema, Harmen B., Al Farii, Humaid, Fernandez-Rodriguez, Diana, Fillingham, Yale A., Fu, Henry, Gallagher, Nicola, Gary, Joshua L., Geerts, William H., Ghazavi, Mohammad T., Gleason, Brendan, Goh, Graham S., Gonçalves, Sérgio, Goriainov, Vitali, Goswami, Karan, Goyal, Lokesh, Granqvist, Mathias, Grenho, André, Griffin, Xavier, Hafez, Mahmoud A., Hakyemez, Ömer Serdar, Hamdi, Sahar, Hansen, Erik N., Hansen, Heather, Hasegawa, Masahiro, Higuera, Carlos A., Hobohm, Lukas M.A., Holc, Fernando, Hollingsworth, Neusha, Hozack, William J., Hughes, Andrew J., Humphrey, Tyler J., Huo, Michael H., Inaba, Yutaka, Jenny, Jean Yves, Jiranek, William, Kaila, Rajiv, Kallel, Sofiene, Kamath, Atul F., Karachalios, Theofilos, Karas, Vasili, Kelkar, Amar H., Keller, Karsten, Kenanidis, Eustathios, Khan, Irfan A., Khan, Yasim, Kim, Jun Ho, Kim, Kang Il, Klein, Gregg R., Kleiner, Justin E., Komnos, George, Konstantinides, Stavros V., Koo, Kyung Hoi, Kopenitz, Jason, Krasinski, Zbigniew, Krueger, Chad A., Kuo, Andy, Kvederas, Giedrius, Kwong, Louis M., Lachiewicz, Paul F., De Ladoucette, Aymard, Larco, Edwin, Larkin, James A., Levine, Brett R., Li, William T., Lieberman, Jay R., Lip, Gregory Y.H., Lizarraga, Marcelo M., Llinás, Adolfo, Lobastov, Kirill, Lobo, Clara A., Ludwick, Leanne, Julian, F., Maempel, Magnuson, Justin, Maini, Lalit, Maltseva, Valentyna, Mamczak, Christiaan N., García-Mansilla, Agustin, Manzaneda, Marzaid E., Martino, Viganò, Al Maskari, Sultan, Matharu, Gulraj S., Mead, Matthew, Meghpara, Michael M., Mehta, Samir, Memtsoudis, Stravos G., Menon, Deepak, Merli Nikolaos Milonakis, Geno J., Mirkazemi, Corinne, Mojica, Jeffery J., Moka, Eleni, Moncman, Tara G., Monsalvo, Daniel, Mortazavi, S. M.Javad, Morton, Jessica, Mulcahey, Mary K., Najafi, Farideh, Nam, Denis, Namdari, Surena, Navarro, Ronald, Nazarian, David G., Niikura, Takahiro, Noyez, Jan F., Ochoa Chaar, Cassius I., Ong, Christian B., Otero-López, Antonio, Ozaki, Toshifumi, Pandit, Hemant, Pannu, Tejbir S., Parvizi, Niosha, Poeran, Jashvant, Poolman, Rudolf W., Purtill, James J., Radoicic, Dragan K., Rajasekaran, Raja Bhaskara, Rajasekhar, Anita, Randelli, Filippo, Reed, Mike, Restrepo, Camilo, Riva, Nicoletta, Romanini, Emilio, Sadek, Mikel, Saglam, Yavuz, Salazar, German, Salazar, Mathias, Salvati, Eduardo A., Samama, Charles Marc, Sánchez-Osorio, Juan S., Santoso, Asep, Sattarzadeh, Roya, Saxena, Arjun, Schemitsch, Emil, Schulman, Sam, Schwenk, Eric S., Shahi, Alisina, Sharkey, Peter F., Sharrock, Nigel, Shivakumar, Sudeep, Shohat, Noam, Siegel, Nicholas M., Sievers, Dennis A., Smailys, Alfredas, Smith, Eric B., Somers, Jan F.A., Souissi, Meriem, Sousa, Paul, Sousa, Ricardo, Spyropoulos, Alex C., Squizzato, Alessandro, Srivastava, Ajay, Suarez, Cristina, Suresh, Suhail, Tannoury, Tony, Tarabichi, Majd, Tarabichi, Saad, Taylor, Jeremiah, Terhune, E. Bailey, Thienpont, Emmanuel, Thomas, Terence L., Top, Alexander C., Tornetta, Paul, Torres, Ana, Torres-Lugo, Norberto J., Tort-Saade, Pedro, Tresgallo-Parés, Ruben, Tsiridis, Eleftherios, Tuncay, Ibrahim, Urbanek, Tomasz, Urish, Kenneth L., Vendittoli, Pascal André, Victor, Klaas, Vilchez, Felix, Villa, Jesus M., Viscusi, Eugene R., Volk, Thomas, Vosooghi, Farzad, Vysotskyi, Olexandr, Whitehouse, Sarah, Parvizi, Javad, Abbas, Azlina A., Abcha, Oussama, Abdelaal, Mohammad S., Ackermann, Paul W., Acuña, Alexander J., Ageno, Walter, Aguilar Ramírez, José J., Akkaya, Mustafa, Alameddine, Dana, Alfaro, David O., Alvand, Abtin, Alzeedi, Muadh, Andrade, Antonio J., Arnold, William V., Arish, Armin, Austin, Matthew S., Ay, Cihan, Azboy, Ibrahim, Babis, George C., Baker, Colin M., Barrack, Robert L., Barragán, Estuardo, Beatón-Comulada, David, Bedair, Hany S., Bell, Jennifer A., Beverland, David E., Bhatia, Nishant, Bialecki, Jerzy, Bondarenko, Stanislav, Bonilla, Guillermo, River Boschert, Salvador Oscar, Bracho, Carlos, Brooks, Dina, Buttaro, Martin, Cacan Daniel Caldeira, Mehmet A., Callaghan, John, Campbell, David G., Cancienne, Jourdan M., Cannegieter, Suzanne C., Canseco, Jose A., Caprini, Joseph A., Carrier, Marc, Castro Bejarano, Juan C., Catani, Fabio, Ceylan, Hasan Huseyin, Cha, Yong Han, Chan, Chee Ken, Chan, Noel, Cheung, Man Hong, Chisari, Emanuele, Cimminiello, Claudio, Citak, Mustafa, Colón-Miranda, Roberto G., Colwell, Clifford, Combs, Kristen, Cordeiro, Minal, Corvi, John J., Courtney Crispiana Cozowicz, P. Maxwell, Crawford, Ross W., Cruz, Eugénia, D'Amore, Taylor, Dantas, Pedro, Della Valle, Alejandro Gonzalez, Deltour, Charles, Demanes, Augustus C., Djaja, Yoshi P., Dunbar, Michael J., Egoavil, Miguel S., Egol, Kenneth A., Eichinger, Sabine, Elías, Luis F., Emmerson, Benjamin R., Ettema, Harmen B., Al Farii, Humaid, Fernandez-Rodriguez, Diana, Fillingham, Yale A., Fu, Henry, Gallagher, Nicola, Gary, Joshua L., Geerts, William H., Ghazavi, Mohammad T., Gleason, Brendan, Goh, Graham S., Gonçalves, Sérgio, Goriainov, Vitali, Goswami, Karan, Goyal, Lokesh, Granqvist, Mathias, Grenho, André, Griffin, Xavier, Hafez, Mahmoud A., Hakyemez, Ömer Serdar, Hamdi, Sahar, Hansen, Erik N., Hansen, Heather, Hasegawa, Masahiro, Higuera, Carlos A., Hobohm, Lukas M.A., Holc, Fernando, Hollingsworth, Neusha, Hozack, William J., Hughes, Andrew J., Humphrey, Tyler J., Huo, Michael H., Inaba, Yutaka, Jenny, Jean Yves, Jiranek, William, Kaila, Rajiv, Kallel, Sofiene, Kamath, Atul F., Karachalios, Theofilos, Karas, Vasili, Kelkar, Amar H., Keller, Karsten, Kenanidis, Eustathios, Khan, Irfan A., Khan, Yasim, Kim, Jun Ho, Kim, Kang Il, Klein, Gregg R., Kleiner, Justin E., Komnos, George, Konstantinides, Stavros V., Koo, Kyung Hoi, Kopenitz, Jason, Krasinski, Zbigniew, Krueger, Chad A., Kuo, Andy, Kvederas, Giedrius, Kwong, Louis M., Lachiewicz, Paul F., De Ladoucette, Aymard, Larco, Edwin, Larkin, James A., Levine, Brett R., Li, William T., Lieberman, Jay R., Lip, Gregory Y.H., Lizarraga, Marcelo M., Llinás, Adolfo, Lobastov, Kirill, Lobo, Clara A., Ludwick, Leanne, Julian, F., Maempel, Magnuson, Justin, Maini, Lalit, Maltseva, Valentyna, Mamczak, Christiaan N., García-Mansilla, Agustin, Manzaneda, Marzaid E., Martino, Viganò, Al Maskari, Sultan, Matharu, Gulraj S., Mead, Matthew, Meghpara, Michael M., Mehta, Samir, Memtsoudis, Stravos G., Menon, Deepak, Merli Nikolaos Milonakis, Geno J., Mirkazemi, Corinne, Mojica, Jeffery J., Moka, Eleni, Moncman, Tara G., Monsalvo, Daniel, Mortazavi, S. M.Javad, Morton, Jessica, Mulcahey, Mary K., Najafi, Farideh, Nam, Denis, Namdari, Surena, Navarro, Ronald, Nazarian, David G., Niikura, Takahiro, Noyez, Jan F., Ochoa Chaar, Cassius I., Ong, Christian B., Otero-López, Antonio, Ozaki, Toshifumi, Pandit, Hemant, Pannu, Tejbir S., Parvizi, Niosha, Poeran, Jashvant, Poolman, Rudolf W., Purtill, James J., Radoicic, Dragan K., Rajasekaran, Raja Bhaskara, Rajasekhar, Anita, Randelli, Filippo, Reed, Mike, Restrepo, Camilo, Riva, Nicoletta, Romanini, Emilio, Sadek, Mikel, Saglam, Yavuz, Salazar, German, Salazar, Mathias, Salvati, Eduardo A., Samama, Charles Marc, Sánchez-Osorio, Juan S., Santoso, Asep, Sattarzadeh, Roya, Saxena, Arjun, Schemitsch, Emil, Schulman, Sam, Schwenk, Eric S., Shahi, Alisina, Sharkey, Peter F., Sharrock, Nigel, Shivakumar, Sudeep, Shohat, Noam, Siegel, Nicholas M., Sievers, Dennis A., Smailys, Alfredas, Smith, Eric B., Somers, Jan F.A., Souissi, Meriem, Sousa, Paul, Sousa, Ricardo, Spyropoulos, Alex C., Squizzato, Alessandro, Srivastava, Ajay, Suarez, Cristina, Suresh, Suhail, Tannoury, Tony, Tarabichi, Majd, Tarabichi, Saad, Taylor, Jeremiah, Terhune, E. Bailey, Thienpont, Emmanuel, Thomas, Terence L., Top, Alexander C., Tornetta, Paul, Torres, Ana, Torres-Lugo, Norberto J., Tort-Saade, Pedro, Tresgallo-Parés, Ruben, Tsiridis, Eleftherios, Tuncay, Ibrahim, Urbanek, Tomasz, Urish, Kenneth L., Vendittoli, Pascal André, Victor, Klaas, Vilchez, Felix, Villa, Jesus M., Viscusi, Eugene R., Volk, Thomas, Vosooghi, Farzad, Vysotskyi, Olexandr, and Whitehouse, Sarah

Published
2022

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