SHM Converge Scientific Abstract ePoster Gallery-Innovative Advanced Practice Provider-Led Orthopedic Surgery Co-Management Program at Community Academic Hospital

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Stanford Health Care Tri-Valley developed an APP-led orthopedic surgery co-management program in 2023 to support growing volumes of complex total hip and knee arthroplasty patients. The program was created in partnership with orthopedic surgery to improve workflow, enhance overnight management of medical comorbidities and postoperative complications, coordinate care across orthopedics, medicine, PT, and OT, and support earlier discharge.<br /><br />The goal was to expand surgical capacity while safely monitoring medically complex patients and reducing strain on attending hospitalists. The program leveraged advance practice providers to manage inpatient co-care for patients requiring extra medical oversight after THA or TKA.<br /><br />From 2022 to 2025, total joint arthroplasty volume increased from 248 to 399 cases, a 60.9% rise. Case mix index also increased, indicating a more medically complex patient population. Overall complication rates remained low at 1.6% across the study period, with a peak of 3.2% in 2025 that was not statistically significant. Hyponatremia was the most common complication, accounting for 61.5% of all events and rising from 1 case in 2022 to 10 cases in 2025. Other tracked complications included DVT/PE, acute kidney injury, acute hypoxic respiratory failure, heart failure exacerbation, and surgical site infection.<br /><br />The authors conclude that APP-driven co-management can safely increase orthopedic surgical throughput, improve monitoring for complex patients, and strengthen collaboration between hospital medicine and surgical teams in a community academic hospital setting.

Asset Subtitle

Kavitha Subramanian

Meta Tag

Author List Jeff Ketchersid, Jingkun (Ginger) Yang, Kavitha Subramanian, Lauren Remer, Nina Ramos

Category Innovations

Concept APP-Led Co-management Program

Concept Orthopedic Surgery

Concept Surgical Volume

Concept Complication

Concept Orthopedic Surgical Throughput

Distinguished Non-Finalist

Presenter Organization Stanford University

Presenting Author Kavitha Subramanian

Track Quality Improvement

Keywords

orthopedic surgery

co-management program

advance practice providers

total hip arthroplasty

total knee arthroplasty

postoperative complications

hospital medicine

surgical throughput

hyponatremia

patient care coordination

APP-Led Co-management Program

Orthopedic Surgery

Surgical Volume

Complication

Orthopedic Surgical Throughput