Pre-Assessment Surgical Screening Clinics Provide a Safe and Equitable Alternative to Primary Care Evaluation in Total Joint Arthroplasty.

Abstract

Preoperative medical clearance for total joint arthroplasty is valuable for identifying factors that could mitigate complication risks. Traditionally, preoperative clearance is obtained through a primary care provider (PCP). Literature has shown that Pre-Assessment Surgical Screening (PASS) clinics may enhance operating room efficiency, decrease surgical cancellations, reduce hospital costs, and improve patient care quality. The goal of this study was to compare 90-day surgical complication and cancellation rates between patients who received preoperative evaluation through a PASS clinic versus a PCP. This retrospective study included patients who underwent primary total joint arthroplasty from January 2017 through January 2024 at a single high-volume joint arthroplasty institute. There were 17,515 patients who met inclusion criteria; 52.3% (n = 9,164) were preoperatively evaluated by the PASS program and 47.7% (n = 8,351) by a PCP. Patient demographics, health characteristics, surgical cancellations, and 90-day complications were collected from patient charts. Outcomes were compared between patients who underwent PCP clearance versus PASS clearance utilizing univariate and logistic regression analyses. On average, patients assessed by the PASS program were older (67 versus 66 years, P = 0.01), had a higher Charlson Comorbidity Index (P ≤ 0.01), and higher American Society of Anesthesiologists scores (P ≤ 0.01). Patients evaluated by a PCP were two times more likely to experience postoperative cardiac arrhythmia (odds ratio [OR]: 1.96; 95% confidence interval [CI]: 1.08 to 3.57; P = 0.03) and wound dehiscence (OR: 1.89; 95% CI: 1.04 to 3.45; P = 0.04). Patients evaluated by the PASS clinic were also 1.5 times more likely to experience periprosthetic joint infection (OR: 1.56; 95% CI: 1.08 to 2.25; P = 0.2). There was no significant difference in readmissions, total 90-day complications, or cancellations between the groups. Patients evaluated by the PASS clinic presented with more comorbidities than patients evaluated by a PCP. Despite these baseline differences, total complications, readmission, and cancellation rates did not significantly differ. Preoperative evaluation clinics can be a helpful resource for mitigating surgical cancellations, postoperative complications, and readmissions in high-risk patient groups.