Editor's Note This population-based analysis finds that implementation of obstructive sleep apnea (OSA) interventions in total joint patients is limited, with some current trends virtually in contrast to practice guidelines. Of more than 1 million patients analyzed, anesthetic techniques did not differ by OSA status, and overall, less than 25%…

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Editor's Note The Centers for Medicare & Medicaid Services on July 13 issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Among the proposals are that Medicare pay for knee replacement procedures performed in outpatient…

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Editor's Note A new report from the Agency for Healthcare Research and Quality (AHRQ) compares the effectiveness of strategies to prevent venous thromboembolism (VTE) in patients having total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery. The study directly compares different types of blood thinners and mechanical…

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Uncertainties pepper the healthcare landscape, but the shift to value-based care is expected to continue, even though momentum may slow under the current administration. That means perioperative services leaders must continue to explore new care delivery options such as the perioperative surgical home (sidebar, p 17). “The demand for value…

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Editor's Note Four new performance measures are available for the Joint Commission’s Total Hip and Total Knee Replacement (THKR) advanced certification program, the Joint Commission announced on July 5. They are: THKR-1 Regional anesthesia THKR-2 Postoperative ambulation on the day of surgery THKR-3 Discharged to home THKR-4 Preoperative functional/health status…

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Editor's Note Emergency department (ED) visits after total joint procedures were numerous and mostly for pain-related diagnoses, and Medicaid patients had almost double the risk of an ED or pain-related ED visit, this study finds. Of 152,783 patients analyzed, 3.42% returned to the inpatient setting and 5.81% visited the ED…

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Editor's Note The global ambulatory services market was valued at $2.3 trillion in 2016 and is forecast to grow to $3.7 trillion by 2024, according to a new study by Ameri Research. In 2016, primary care offices accounted for the majority of market share at more than 48% because they…

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Editor's Note The American College of Rheumatology (ACR) and American Association of Hip and Knee Surgeons (AAHKS) have released a new guideline to help reduce postoperative total hip and knee infections through the perioperative management of antirheumatic medications. Among the recommendations: Discontinuing biologic therapy before surgery in patients with inflammatory…

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Editor's Note Discharge from the postanesthesia care unit (PACU) without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty did not increase length of hospital stay or readmissions but significantly reduced time in the PACU (0.40 vs 1.56 hours), this study finds. This multicenter…

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Editor's Note Using patient-specific preoperative variables, a validated logistic regression model predicted transfusions in total hip and knee patients in this study. The model identified preoperative hemoglobin, total hip arthroplasty, and females 65 years of age and older as predictors of perioperative transfusions. The model also may help identify those…

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