2019 Joint Replacement Outcomes at UW Valley Medical Center with focus on infection
The Covid-19 pandemic delayed our annual review of outcomes
but I have reviewed the data and compared it to expected results nationally. At
the joint center at UW Valley Medical Center, we track our outcomes so we can
reliably discuss with our patients our results and complications rather than
quoting literature which may or may not reflect the results at a particular
practice. We then can compare our results against national norms or best
practices to accomplish continual quality improvement.
Starting with total hip replacement (THR) our average length
of stay (LOS) was 1.11 days, this compares favorably with the benchmark for the
top 10% of hospitals nationally of 1.3 days and an average LOS of 1.7 days
nationally. Our 30-day readmission rate (people who had to be readmitted after
surgery within 30 days post-op.) was 1.46% which is significantly better than
the expected result nationally. Our infection rate for THA was 0.42% which
compares favorably to a national infection rate which ranges between 1-2%.
For total knee replacement (TKR) our average LOS was 1.2
days which compares favorably to the top 10% of hospitals average of 1.46 days
and significantly better than the national average of 1.8 days. Our 30-day readmission rate was 1.8% which was less than half the expected rate
nationally. Our infection rate was 0.6% which is substantially lower than the
national average of 1-2%.
Reviewing the data indicates our patients go home sooner,
have a lower rate of readmission, and lower infection rates than the top 10% of
hospitals nationally. There are several keys to our good outcomes. First, we
have a small group of joint replacement surgeons all of whom perform a high
volume of joint replacements. Our pre and post-op pathways are standardized
which minimize Covid variance. We have a very specific patient optimization program
to prepare patients for their joint replacement.
In the March 2020 issue
of the Journal of Arthroplasty Dr. Goswami and co-authors from the Rothman
Institute in Philadelphia outlined the best practices intraoperatively and
postoperatively to minimize the risk of infection. We have adopted these many
years ago and utilize other strategies preoperatively to minimize the risk of
infection. These include using chlorhexidine showers for 3 days prior to
surgery, chlorhexidine wipes prior to surgery, iodine nasal swabs to minimize
nasal contamination, preoperative IV antibiotics within 60 minutes of surgery,
use of tranexamic acid to minimize blood loss, efficient use of operating room
time to minimize wound exposure and specialized wound closure with silver-impregnated dressings. In special cases, we will use negative pressing wound dressings.
All of these efforts when combined help us keep our infection rates low.
We appreciate all the patients who have trusted us with
their care especially in these difficult Covid times.