older couple hiking

2019 Joint Replacement Outcomes at UW VMC

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.