Continuity of primary care and emergency department visits following knee and hip replacement surgery: a retrospective cohort study.

Abstract

Background: Continuity of primary care (CPC) improves patient well-being, but the association between CPC and surgical outcomes has not been well studied. The numbers of joint replacement procedures are expected to rise considerably in the coming years, so it is crucial to identify factors related to successful outcomes. The purpose of this study was to examine the association between CPC and emergency department (ED) visits after knee and hip replacement surgery. Methods: Physician claims and hospital data from 2005 to 2020 in Nova Scotia were used in this retrospective study. To measure CPC, we used the Modified Modified Continuity Index (MMCI), which is the number of primary care providers adjusted for the total number of visits. The outcome was ED visits within 90 days of discharge. Logistic regression was used to test for associations between MMCI and the probability of an ED visit. Results: There were 28 574 knee and 16 767 hip procedures in the data set; 13.9% (95% confidence interval [CI] 13.5%–14.3%) and 13.5% (95% CI 13.0%–14.0%) of the patients, respectively, had an ED visit within 90 days. For patients who underwent knee procedures, the mean MMCI was 0.868 (95% CI 0.867–0.870); 10.7% (95% CI 10.4 %–11.1 %) had perfect continuity of care. For patients who underwent hip procedures, the corresponding measures were 0.864 (95% CI 0.862–0.866) and 13.5% (95% CI 13.0%–14.0%). There was a statistically significant negative association between greater continuity of care and the probability of an ED visit after controlling for confounders. Conclusion: Having multiple primary care providers before surgery increased the likelihood of negative outcomes following knee or hip replacement surgery compared with having a single provider. Presurgical conversations should include primary care history to improve postsurgical outcomes.