Journal of Current Scientific Research

Current Issue Volume No: 1 Issue No: 2

ISSN: 2766-8681
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    Changes in Orthopedic Surgery at the Community Level

    Ronald Lagoe 1   Mark Murphy 2   Shelly Littau 3  

    1Hospital Executive Council, Syracuse, New York, 13235, USA

    2St Joseph’s Hospital Health Center, Syracuse, NY 13203,

    3Hospital Executive Council, Syracuse, New York, 13235, USA

    Author Contributions
    Received 03 May 2021; Accepted 04 May 2021; Published 06 May 2021;

    Copyright ©  2021 Ronald Lagoe, et al.

    License
    Creative Commons License     This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Ronald Lagoe, Mark Murphy, Shelly Littau (2021) Changes in Orthopedic Surgery at the Community Level . Journal of Current Scientific Research - 1(2):21-23.

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    DOI 10.14302/issn.2766-8681.jcsr-21-3834

    Introduction

    In the United States, the delivery of health care is changing at the community level. The media has focused attention on health care in relation to the Corona virus, but not all of the recent changes are related to the epidemic.

    Historically, the delivery of health care has evolved over time. This has been especially true with respect to the delivery of care. Health care providers have been conservative professionals. They have altered their practice patterns slowly.

    A recent example of changes in healthcare practice at the community level is movement of surgical procedures from inpatient to outpatient settings. Minor surgical procedures have been carried out in ambulatory settings for decades, but recently there have been some notable recent additions.

    One of these developments has been the shift of additional orthopedic surgery procedures, such as joint replacements, from inpatient hospitals to outpatient facilities. This trend has been apparent during the past three years.

    This development has been supported by several factors. A number of orthopedic procedures frequently involve healthy patients, who can undergo orthopedic surgery without the need for inpatient hospital admission. Health care payers such as Medicare have agreed to reimburse these procedures on an outpatient basis.

    Method

    This analysis reviewed the movement of certain orthopedic surgery patients from inpatient to outpatient settings. The procedures included hip and knee joint replacements, as well as a wider range of orthopedic surgery.

    The analysis involved these procedures in the hospitals of Syracuse, New York. These Providers include Crouse Hospital (17,204 inpatient discharges excluding well newborns – 2020), St. Joseph’s Hospital Health Center (21,328 inpatient discharge- 2020), and Upstate University Hospital (30,988 inpatient discharges – 2020).

    Historically, these hospitals have provided a full range acute care to an immediate service area with a population of approximately 600,000. They have also provided specialty services to the eleven county Central New York health service area with a population of approximately 1,400,000.

    The analysis focused on comparison of inpatient orthopedic discharges for hip replacements, knee replacements, and other orthopedic surgery by severity of illness during a three year period. The comparisons involved patients discharged in July 2018 – January 2019, July 2019 – January 2020, and July 2020 – January 2021 to avoid the impact of the Corona virus epidemic in the first half of 2020.

    The results of this analysis are summarized in this table 1. This information included combined orthopedic surgery utilization for the Syracuse hospitals during the three seven month periods.

    Table 1. Inpatient Hospital Discharges: Hip & Knee Joint Replacement and Total Orthopedics Surgery by Severity of Illness Syracuse Hospitals July - January 2018 - 2021
      Severity of Illness
      Minor Moderate Major Extreme Total
    APR DRG 301 - Hip Joint Replacement          
    2018 - 2019 526 575 53 19 1,173
    2019 - 2020 477 588 52 25 1,142
    2020 - 2021 312 417 55 20 804
    Difference 2018 - 2020 -214 -158 2 1 -369
     
    APR DRG 302 - Knee Joint Replacement          
    2018 - 2019 595 522 31 7 1,155
    2019 - 2020 565 394 31 4 994
    2020 - 2021 235 219 33 7 494
    Difference 2018 - 2020 -360 -303 2 0 -661
     
    APR DRGs 301 - 322 - Orthopedic Surgery        
    2018 - 2019 1,956 2,191 495 100 4,742
    2019 - 2020 1,887 2,050 497 130 4,564
    2020 - 2021 1,226 1,636 495 127 3,484
    Difference 2018 - 2020 -730 -555 0 27 -1,258

    Data include patients aged 18 years and over. Source: Hospital Executive Council.

    The data demonstrated that, from July 2018 – January 2019 to July 2020 – January 2021, numbers of inpatient discharges for hip joint replacement declined by 31.5 percent, from 1,173 – 804; discharges for total knee replacement declined by 57.2 percent, from 1,155 to 494; and other orthopedic surgery declined by 26.5 percent, from 4,742 to 3,484 in the Syracuse hospitals.

    The data also indicated that almost all of the reductions in inpatient discharges involved relatively healthy patients, those at Minor or Moderate severity of illness. These patients accounted for 372 hip replacements, 663 knee replacements and 1,285 for those with other orthopedic surgery.

    The largest declines also involved patients at Minor severity of illness. They included 40.7 percent of hip replacements, 60.5 percent of knee replacements, and 37.3 percent of other orthopedic surgery.

    These data provide an example of changes in health care utilization that develop over time. They suggest the need for careful planning by providers and payers in order to monitor and address these developments.