Health Outcomes for UPMC Total Joint Replacement Patients in Allegheny County, Pennsylvania After Engaging in a Tobacco Cessation Pre-Surgical PathwayBober, Nicholas Edward (2024) Health Outcomes for UPMC Total Joint Replacement Patients in Allegheny County, Pennsylvania After Engaging in a Tobacco Cessation Pre-Surgical Pathway. Master Essay, University of Pittsburgh.
AbstractBackground: Cigarette smoking remains the leading cause of preventable death as of 2022 and less than one in ten who attempt to quit succeed due to numerous barriers. Various cessation methods have been created to get past these barriers, with combining these methods being found to be most successful. The objective of this study was to use brief interventions of Motivational Interviewing, in addition to nicotine replacement therapy (NRT) and patient health education to determine if there is any association with combining methods regarding cessation rates and patient-reported health outcomes in a pathway where patients are required to quit smoking before having joint replacement surgery. Methods: Records of 16474 surgeries on 14514 individual patients were obtained from the UPMC Wolff Data Center from four UPMC hospitals in Allegheny County from June 1st 2018 through April 30th 2023. Health outcomes were divided into three patient-reported measures: Hip dysfunction and Osteoarthritis Outcome Score (HOOS) and Knee injury and Osteoarthritis Outcome Score (KOOS) to measure pain and functionality in the hip and knee, while Patient-Reported Outcomes Measurement Information System Mental Score (PROMIS10) measured a general idea of health through the patient’s perception of their health . Health complications, death rates, and readmission rates were all determined using logistic regression to see if any association exists. Final smoking status was also analyzed to determine if there was any association with complications or other events. Patient characteristics were controlled to best determine if a relationship was present. Results: There were 427 entries in the intervention pathway and 16110 entries outside of the pathway group in Allegheny County. There were significant associations with worse outcome scores before and after surgery, but there was a significant association in change over time for each outcome to show that the Tobacco Treatment Telehealth Service (TTTS) Pathway was still beneficial. Over half of the participants in the TTTS Pathway successfully quit before surgery. Conclusions: Determining the effect of pre-surgery smoking cessation can help better enhance motivation to quit with elective surgeries. This study can serve as a resource to reduce the public health burden that smoking has on healthcare. Share
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