Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty.
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The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was performed. The mean length of stay was 2.9 days and 29.0% of patients were discharged to extended care facilities. Age, caregiver support at home, and patient expectation of discharge destination were the only significant multivariable predictors regardless of the type of surgery (total knee versus total hip arthroplasty). Among those variables, patient expectation was the most important predictor (P < 0.001; OR 169.53). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a high concordance index of 0.969.
Published Version (Please cite this version)
Halawi, Mohamad J, Tyler J Vovos, Cindy L Green, Samuel S Wellman, David E Attarian and Michael P Bolognesi (2015). Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty. J Arthroplasty, 30(4). pp. 539–542. 10.1016/j.arth.2014.10.031 Retrieved from https://hdl.handle.net/10161/10288.
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Longitudinal Data Analysis
Clinical Trial Methods
Maximum Likelihood Methods
My career has primarily focused on clinical care of hip and knee arthritis. I run a busy Adult Reconstruction (hip and knee replacement) practice. I am also Chief of the Orthopedic Surgery service at the Durham VA medical center. In these roles, I work daily with orthopedic residents, and train them to manage these issues both non-operatively and with surgery. I also mentor residents, fellows,and medical students on their research projects, typically in collaboration with my clinical partner, Michael Bolognesi, MD. We often have multiple residents working on a variety of projects at once. My research interests lie mainly with clinical research in hip and knee replacement, including biomechanical studies, outcomes research, and clinical trials. I have also begun collaborating with basic science colleagues on biomarker research
Investigation of value based healthcare markets and transitions. Cost transparency for patients and providers.
Risk management and medicolegal aspects of orthopaedic practice.
Co-management and alignment relationships between clinicians and hospitals/ health systems in evolving healthcare markets.
Clinical outcomes of total hip and knee replacements (primary and revision surgeries, total joint infections, modern bearing surfaces, gait mechanics and balance).
Novel surgical techniques for difficult adult hip and knee reconstruction cases.
Development of quality and efficiency metrics in an Academic practice; correlation of work culture with patient satisfaction and experience.
Development of value based compensation plans for physcians.
Effect of comorbidities on surgical outcomes and complications: anemia, diabetes, smoking, obesity, depression-anxiety
As chief of the adult reconstruction service, the majority of my research effort has been directed toward clinical outcomes, implant survivorship, functional recovery, the biology of hip and knee arthritis and cost effectiveness.
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