Accelerated Discharge Following Total Knee Arthroplasty May Be Safe in a Teaching Institution

J Knee Surg DOI: 10.1055/s-0038-1676066Total knee arthroplasty (TKA) is one of the most commonly performed yet costly surgical procedures in orthopaedics. With national trends and reimbursements moving in favor of shorter hospital length-of-stay (LOS), it is important to understand the complications associated with discharging patients earlier. This is particularly more challenging in a teaching institution due to complexity and variety of layers of care. Therefore, the purpose of this study was to evaluate the 90-day postoperative outcomes among those who were discharged on postoperative day 2 (POD-2) and compare them to a cohort whom had a LOS ≥ 3 days. A retrospective review of all patients who underwent a primary TKA from at a single-teaching institution from 2015 to 2017 was performed. During this time, an accelerated discharge protocol was designed and implanted in our institution. We identified 485 patients who were then substratified into two groups: patients who were discharged on POD-2 (n = 91) with the accelerated protocol and those who were discharged ≥ 3 days (n = 394). Outcomes evaluated included (1) demographics, (2) readmission rates, (3) emergency room (ER) visits, and (4) complication rates within 90 days of TKA. The POD-2 cohort was significantly younger than patients with ≥ 3-day LOS (64 vs. 69 years; p = 0.0001). There were no differences in gender ratios between ...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

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Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:Hypopnea definition has a major effect on AHI and on OSA prevalence in the general population and, hence, important implications for public health policies. There is a twofold difference in the threshold above which an association with diabetes, hypertension, and metabolic syndrome is observed using AASM2007 compared to AASM1999 or AASM2012 criteria.Citation:Hirotsu C, Haba-Rubio J, Andries D, Tobback N, Marques-Vidal P, Vollenweider P, Waeber G, Heinzer R. Effect of three hypopnea scoring criteria on OSA prevalence and associated comorbidities in the general population.J Clin Sleep Med. 2019;15(2):183–194.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Study Objectives:Overnight pulse oximetry (OPO) is commonly used as a screening test for obstructive sleep apnea. Heart rate variability (HRV) correlates well with apnea-hypopnea index during polysomnography (PSG). We hypothesized that visual correlation of episodic increase in HRV with minimal oxygen desaturations on normal OPO (oxygen desaturation index less than 5 events/h) is predictive of OSA.Methods:A retrospective analysis of patients undergoing OPO and PSG in 1 year was performed. We included only OPO performed on room air and interpreted as normal. Visual correlation between simultaneous increase in HRV and minima...
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Study Objectives:The aim of this study was to determine whether severity measures of obstructive sleep apnea (OSA) are associated with arterial stiffness and central blood pressure (two important cardiovascular risk factors) in a large group of patients with OSA.Methods:Baseline data from six studies on OSA in which arterial stiffness and central aortic blood pressure measures were determined using applanation tonometry were pooled. Associations between measures of arterial stiffness (heart rate corrected augmentation index [AI75]), central aortic blood pressure (central systolic pressure [CSP] and heart rate corrected cen...
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:Albuminuria and levels of three serum markers of AKI (cystatin C, NGAL, IL-18) were positively correlated with OSA severity, and good adherence with CPAP treatment decreased albuminuria and interleukin-18 levels. These results may provide additional tools for assessing early renal injury in patients with OSA.Citation:Chuang LP, Lin SW, Lee LA, Chang CH, Huang HY, Hu HC, Kao KC, Hsieh MJ, Yang CT, Li HY, Chen NH. Elevated serum markers of acute kidney injury in patients with obstructive sleep apnea.J Clin Sleep Med. 2019;15(2):207–213.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:Sleep quality was positively associated with FIMT among adolescents, whereas physical activity and adiposity did not mediate this process.Citation:Cayres SU, Vanderlei LC, Machado-Rodrigues AM, Werneck AO, Barbosa MF, Fernandes RA. Adiposity and physical activity do not mediate the longitudinal association between sleep quality and arterial thickness among adolescents.J Clin Sleep Med. 2019;15(2):215–221.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:Data showed that the coexistence of insomnia and CMP results in greater pain intensity and alterations in sleep homeostasis. Collectively, the data indicate that there is a bidirectional and directly proportional relationship between sleep duration and pain intensity in women who are postmenopausal with insomnia. This result strongly suggests that both sleep and pain conditions should be targeted in the treatment of women who are postmenopausal.Citation:Frange C, Hachul H, Hirotsu C, Tufik S, Andersen ML. Temporal analysis of chronic musculoskeletal pain and sleep in postmenopausal women.J Clin Sleep Med. 2019;15(2):223–234.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
This study utilized data from the annual, cross-sectional 2016 US National Health and Wellness Survey. Respondents self-reporting an OSA diagnosis were categorized as having ES (Epworth Sleepiness Scale [ESS] score≥ 11) or not having ES (ESS score
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:CMS adherence criteria affecting PAP coverage are restrictive and can result in the withholding of therapy in many patients who otherwise might become adherent.Clinical Trial Registration:Registry: ClinicalTrials.gov, Title: Remote Monitoring in Obstructive Sleep Apnea, Identifier: NCT01678560, URL:https://clinicaltrials.gov/ct2/show/NCT01678560Citation:Naik S, Al-Halawani M, Kreinin I, Kryger M. Centers for Medicare and Medicaid Services positive airway pressure adherence criteria may limit treatment to many medicare beneficiaries.J Clin Sleep Med. 2019;15(2):245–251.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
Conclusions:Results point to a possible overlap in brain mechanisms involved in nightmare dysphoria (during sleep) and distress (during wakefulness) among individuals who frequently recall nightmares. They provide partial support for a neurocognitive model of nightmares.Commentary:A commentary on this article appears in this issue on page 179.Citation:Marquis LP, Julien SH, Baril AA, Blanchette-Carrière C, Paquette T, Carr M, Soucy JP, Montplaisir J, Nielsen T. Nightmare severity is inversely related to frontal brain activity during waking state picture viewing.J Clin Sleep Med. 2019;15(2):253–264.
Source: Journal of Clinical Sleep Medicine : JCSM - Category: Sleep Medicine Source Type: research
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