Table 3.
Recommendations for metrics to evaluate preoperative risk factor management programs
| Metrics | Tier 1 Analysis | Tier 2 Analysis |
| Patient characteristics | ||
| Specific stratified analyses for patient outcomes should be performed, examining: | ||
| Race | X | X |
| Ethnicity | X | X |
| Age | X | X |
| Gender | X | X |
| Insurance status | X | X |
| Income | X | |
| Patient factors | ||
| Institution’s acceptable patient risk level to proceed with surgery (that is, if scorea, maximum allowable score to proceed with surgery) | X | X |
| Comorbidities (such as BMI, DM, hypertension, heart disease, or depression) | X | X |
| Quantification of patient risk during the initial presentation (the initial risk scorea) | X | |
| Quantification of patient risk at POD 0 (the risk scorea at POD 0) | X | |
| Social support (lives alone, family support) | X | |
| Housing status | X | |
| Program factors | ||
| Institution hard-stop values for HgA1C, BMI, and albumin levels | X | X |
| Percentage of patients for whom conservative management is recommended over surgery based on high risk | X | |
| Percentage of patients participating in program who subsequently undergo TJA after spending 6 months in the risk management program | X | |
| Average time patients spend in program before undergoing TJA | X | |
| Total number of referrals to specialists per patient | X | |
| Total number of successfully completed referrals to specialist per patient | X | |
| Average wait time in days to see a specialist | X | |
| Specialists accept Medicaid, yes or no? (including bariatrics, nutrition or metabolic clinic, dental, endocrinology, infectious disease, cardiology, nephrology, psychiatry, and hematology departments) | X | |
| Partnerships established with social work programs that accept Medicaid or uninsured patients (alcohol use, substance use, psychology, smoking cessation, or social work) | X | |
| Surgical factors | ||
| Inpatient versus outpatient surgery | X | X |
| LOS | X | X |
| Postdischarge resources needed (inpatient rehabilitation, SNF, home PT or nursing, outpatient PT or telerehabilitation for postoperative PT) | X | X |
| 30- and 90-day readmissions and ED visits | X | X |
| Transfusion usage | X | X |
| Frequency of SSI | X | X |
| Patient-reported outcome measures | X | |
a
Refer to review by Howie et al. [33] for scoring tools; DM = diabetes mellitus; LOS = length of stay; POD = postoperative day; HbA1c = hemoglobin A1c; SNF = skilled nursing facility; PT = physical therapy; ED = emergency department; SSI = surgical site infection.