An Orthopedic Surgeon’s Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System

Erik Y. Tye, MD; Adam J. Taylor, MD; Robert D. Kay, MD; Jason A. Bryman, MD; John P. Andrawis, MD, MBA; Robert P. Runner, MD

Arthroplasty Today (Dec 2021)

An Orthopedic Surgeon’s Dental Examination: Reducing Unnecessary Delays in Joint Replacement Surgery for Marginalized Patients in a Safety Net Hospital System

Erik Y. Tye, MD,
Adam J. Taylor, MD,
Robert D. Kay, MD,
Jason A. Bryman, MD,
John P. Andrawis, MD, MBA,
Robert P. Runner, MD

Affiliations

Erik Y. Tye, MD: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA; Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA; Corresponding author. 1000 W Carson St, Torrance CA, 90503.
Adam J. Taylor, MD: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA; Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
Robert D. Kay, MD: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA; Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
Jason A. Bryman, MD: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA; Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
John P. Andrawis, MD, MBA: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA; Harbor-University of California, Los Angeles, Medical Center, Torrance, CA, USA
Robert P. Runner, MD: Rancho Los Amigos National Rehabilitation and Medical Center, Downey, CA, USA

Journal volume & issue: Vol. 12
pp. 76 – 81

Abstract

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Background: Selective dental clearance before total joint arthroplasty (TJA) has been proposed; however, effective strategies of carrying out this practice are lacking. This study aims to determine the positive predictive value (PPV) of a novel oral examination performed by an orthopedic surgeon to better direct limited resources for marginalized patients in a safety net hospital system. Methods: A retrospective review was conducted on 105 consecutive patients who had an oral examination performed by a single surgeon before elective TJA. Patients who screened negative proceeded to surgery without further formal dental clearance. Patients who screened positive underwent formal examination/intervention by a dentist before surgery. The rate of correct referral that resulted in patients undergoing an oral surgical intervention was determined. Complications during a minimum 90-day postoperative follow-up period were collected and compared. Results: Thirty patients (28.6%) screened positive while 75 patients (71.4%) screened negative and proceeded to surgery without referral. The PPV of the screening test was high, with 73.3% of patients receiving a major surgical oral intervention before TJA. Patients sent for formal referral required 89.1 more days to receive their surgery than those that screened negative (54.9 days ± 4.24 vs 144.0 days ± 82.4, P < .001). Conclusion: An orthopedic surgeon’s oral examination demonstrates a high PPV to identify high-risk patients in need of an oral surgical intervention before TJA. This provides a unique solution regarding over-referral for preoperative dental clearance and avoids delays for marginalized patients considering elective TJA in a safety net hospital system.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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Abstract

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