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Shimizu MR, Buddhiraju A, Kwon OJ, Chen TLW, Kerluku J, Kwon YM. Are social determinants of health associated with an increased length of hospitalization after revision total hip and knee arthroplasty? A comparison study of social deprivation indices. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05414-2. [PMID: 38953943 DOI: 10.1007/s00402-024-05414-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Length of stay (LOS) has been extensively assessed as a marker for healthcare utilization, functional outcomes, and cost of care for patients undergoing arthroplasty. The notable patient-to-patient variation in LOS following revision hip and knee total joint arthroplasty (TJA) suggests a potential opportunity to reduce preventable discharge delays. Previous studies investigated the impact of social determinants of health (SDoH) on orthopaedic conditions and outcomes using deprivation indices with inconsistent findings. The aim of the study is to compare the association of three publicly available national indices of social deprivation with prolonged LOS in revision TJA patients. MATERIALS AND METHODS 1,047 consecutive patients who underwent a revision TJA were included in this retrospective study. Patient demographics, comorbidities, and behavioral characteristics were extracted. Area deprivation index (ADI), social deprivation index (SDI), and social vulnerability index (SVI) were recorded for each patient, following which univariate and multivariate logistic regression analyses were performed to determine the relationship between deprivation measures and prolonged LOS (greater than five days postoperatively). RESULTS 193 patients had a prolonged LOS following surgery. Categorical ADI was significantly associated with prolonged LOS following surgery (OR = 2.14; 95% CI = 1.30-3.54; p = 0.003). No association with LOS was found using SDI and SVI. When accounting for other covariates, only ASA scores (ORrange=3.43-3.45; p < 0.001) and age (ORrange=1.00-1.03; prange=0.025-0.049) were independently associated with prolonged LOS. CONCLUSION The varying relationship observed between the length of stay and socioeconomic markers in this study indicates that the selection of a deprivation index could significantly impact the outcomes when investigating the association between socioeconomic deprivation and clinical outcomes. These results suggest that ADI is a potential metric of social determinants of health that is applicable both clinically and in future policies related to hospital stays including bundled payment plan following revision TJA.
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Affiliation(s)
- Michelle Riyo Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Oh-Jak Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Tony Lin Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jona Kerluku
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Brennan JC, Rana PC, Johnson AH, Turcotte JJ, King PJ. Same-Day Discharge Does Not Increase Resource Utilization Within One Year of Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00524-2. [PMID: 38797452 DOI: 10.1016/j.arth.2024.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND While the safety of rapid recovery total joint arthroplasty is well established, less is known about its impact on postoperative care utilization patterns. We wished to examine whether same-day discharge-and its associated presumed reduction in hospital-based postoperative care and education-translates to the need for more postoperative support during the 1-year recovery period. METHODS A retrospective review of 1,237 total hip arthroplasty (THA) and 1,710 total knee arthroplasty (TKA) patients who had 0- or 1-day length of stay (LOS) from January 2020 to October 2023 was conducted. The primary outcome was the number of follow-up visits with total joint arthroplasty providers at our institution during the 1-year postoperative period. Secondary outcomes included 30-day emergency department returns, readmissions, 1-year physical therapy utilization, and improvement in Patient-Reported Outcomes Measurement Information System Physical Function scores at 6 to 12 months postoperatively. Bivariate and multivariable analyses were performed to compare outcomes between 0-day and 1-day LOS THA and TKA patients. RESULTS In both the THA and TKA populations, 0-day LOS patients were younger, had a lower average body mass index, were more likely to be White, men, and had an American Society of Anesthesiologists score < 3 than 1-day LOS patients. After controlling for differences between groups, no significant differences in the number of one-year follow-up visits, physical therapy visits, emergency department returns, or readmissions were seen between 0 and 1-day THA or TKA patients. In TKA patients, 1-day LOS was associated with lower improvements in Patient-Reported Outcomes Measurement Information System Physical Function scores. CONCLUSIONS After risk adjustment, same-day discharge of THA and TKA patients did not result in increased resource utilization during the one-year postoperative period. In the setting of a coordinated joint arthroplasty program with nurse navigator support, same-day discharge can be safely performed without increasing the need for postoperative care in appropriately selected patients undergoing both THA and TKA.
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Affiliation(s)
- Jane C Brennan
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Parimal C Rana
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Andrea H Johnson
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Justin J Turcotte
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
| | - Paul J King
- Luminis Health Orthopedics, Anne Arundel Medical Center, Annapolis, Maryland
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Shimizu MR, Lin-Wei Chen T, Buddhiraju A, Bacevich B, Huang Z, Kwon YM. Neighborhood socioeconomic disadvantages associated with prolonged length of stay and non-home discharge following revision total hip and knee joint arthroplasty. J Clin Orthop Trauma 2024; 52:102428. [PMID: 38766389 PMCID: PMC11097079 DOI: 10.1016/j.jcot.2024.102428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
Background Discharge disposition and length of stay (LOS) are widely recognized markers of healthcare utilization patterns of total hip and knee joint arthroplasty (TJA). These markers are commonly associated with increased postoperative complications, patient dissatisfaction, and higher costs. Area deprivation index (ADI) has been validated as a composite metric of neighborhood-level disadvantage. This study aims to determine the potential association between ADI and discharge disposition or extended LOS following revision TJA. Methods This study conducted a retrospective analysis of a consecutive series of revision hip and knee TJA patients from a single tertiary institution. Univariate and multivariate regression analysis was used to determine the association between ADI and discharge disposition or LOS, adjusting for patient demographics and comorbidities. Results 1047 consecutive revision TJA patients were identified across 463 different neighborhoods. 193 (18.4 %) had an extended LOS, and 334 (31.9 %) were discharged to non-home facilities. Compared with Q1 (least deprived cohort), Q2 (odds ratio [OR] = 1.63; p = 0.030) and Q4 (most deprived cohort: OR = 2.04; p = 0.002) cohorts demonstrated higher odds of non-home discharge. Patients in the highest ADI quartile (most deprived cohort) were associated with increased odds of prolonged LOS following revision TJA compared to those in the lowest ADI quartile (OR = 2.63; p < 0.001). Conclusion This study suggests that higher levels of neighborhood-level disadvantage may be associated with higher odds of non-home discharge and prolonged LOS following revision TJA. Development of interventions based on the area deprivation index may improve discharge planning and reduce unnecessary non-home discharges in patients living in areas of socioeconomic deprivation.
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Affiliation(s)
- Michelle Riyo Shimizu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tony Lin-Wei Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anirudh Buddhiraju
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Blake Bacevich
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziwei Huang
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Sharma S, Miller AS, Pearson Z, Tran A, Bahoravitch TJ, Stadecker M, Ahmed AF, Best MJ, Srikumaran U. Social determinants of health disparities impact postoperative complications in patients undergoing total shoulder arthroplasty. J Shoulder Elbow Surg 2024; 33:640-647. [PMID: 37572748 DOI: 10.1016/j.jse.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Understanding the role of social determinants of health disparities (SDHDs) in surgical outcomes can better prepare providers to improve postoperative care. In this study, we use International Classification of Diseases (ICD) codes to identify SDHDs and investigate the risk of postoperative complication rates among patients undergoing total shoulder arthroplasty (TSA). METHODS A retrospective cohort analysis was conducted using a national insurance claims database. Using ICD and Current Procedural Terminology (CPT) codes, patients who underwent primary TSA with at least 2 years of follow-up in the database were identified. Patients with a history of SDHDs were identified using appropriate ICD-9 and ICD-10 codes. Patients were grouped in one of 2 cohorts: (1) patients with no history of SDHDs (control) and (2) patients with a history of SDHDs (SDHD group) prior to TSA. The SDHD and control groups were matched 1:1 for comorbidities and demographics prior to conducting multivariable analysis for 90-day medical complications and 2-year surgical complications. RESULTS After matching, there were 8023 patients in the SDHD group and 8023 patients in the control group. The SDHD group had significantly higher odds for 90-day medical complications including heart failure, cerebrovascular accident, renal failure, deep vein thrombosis, pneumonia, sepsis, and urinary tract infection. Additionally, the SDHD group had significantly higher odds for revision surgery within 2 years following TSA. Patients in the SDHD group also had a significantly longer length of hospital stay following TSA. DISCUSSION This study highlights the association between SDHDs and postoperative complications following TSA. Quantifying the risk of complications and differences in length of stay for TSA patients with a history of SDHDs is important in determining value-based payment models and risk stratifying to optimize patient care.
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Affiliation(s)
- Sribava Sharma
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew S Miller
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachary Pearson
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Tran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tyler J Bahoravitch
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Monica Stadecker
- Department of Orthopaedic Surgery, George Washington University School of Medicine, Washington, DC, USA
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Best
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Fu H, Wang C, Afzal I, Kader D, Asopa V, Sochart D. The effect of BMI and other factors on post-operative length of stay: A multivariable regression analysis of 860 patients undergoing total knee arthroplasty. Knee 2023; 42:82-89. [PMID: 36924531 DOI: 10.1016/j.knee.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/19/2023] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is a trend towards minimising length of stay (LOS) after total knee arthroplasty (TKA), as greater LOS is associated with poorer outcomes and higher costs. Patient factors known to influence LOS post-TKA include age and ASA grade. Evidence regarding the effect of body mass index (BMI) in particular is conflicting, with some studies finding that increased BMI predicts increased LOS, while others have found no relationship. Few previous studies, which have mostly been conducted outside the UK, have examined the effect of living alone or socioeconomic deprivation, which may be confounders. METHODS We conducted a retrospective cohort study of 1031 consecutive primary TKAs performed between 1 April 2021 and 31 December 2021 in a single high-volume arthroplasty centre. A multivariable negative binomial regression model was performed for the 860 patients with complete data, using pre-operative (BMI, age, gender, ASA grade, smoking, ethnicity, socioeconomic deprivation, living arrangement, EQ5D quality of life score, and indication for surgery) and peri-operative variables (surgeon, surgical approach, tourniquet use, a.m./p.m operation, operation side, duration, and day of the week). RESULTS Mean LOS was 2.6 days. BMI and socioeconomic deprivation had no effect on LOS (P > 0.05). Increased LOS was associated with living alone, lower EQ5D, age and ASA grade (all P < 0.001), p.m. operation (P < 0.01), female gender and duration of surgery (P < 0.05). CONCLUSION BMI and socioeconomic status were not correlated with LOS after TKA. Living alone, which has not been previously reported and lower pre-operative EQ5D status were significant risk factors, which merit consideration in pre-operative planning and counselling.
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Affiliation(s)
- Howell Fu
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK.
| | - Chao Wang
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK
| | - Irrum Afzal
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK
| | - Deiary Kader
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK
| | - David Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom General Hospital, Epsom, UK
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Katakam A, Collins AK, Sauder N, Shin D, Bragdon CR, Chen AF, Melnic CM, Bedair HS. Obesity Increases Risk of Failure to Achieve the 1-Year PROMIS PF-10a Minimal Clinically Important Difference Following Total Joint Arthroplasty. J Arthroplasty 2021; 36:S184-S191. [PMID: 33303327 DOI: 10.1016/j.arth.2020.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The aims of this study were to determine if increasing body mass index (BMI) is a risk factor for failure to attain the 1-year Patient Reported Outcomes Measurement Information System Physical Function (PROMIS PF-10a) minimal clinically important difference (MCID) following total joint arthroplasty (TJA) and to determine a possible BMI threshold beyond which this risk increases significantly. METHODS This retrospective study was performed using 3506 TJAs sourced from a regional-based registry. An anchor-based MCID threshold of 7.9 was chosen. PROMIS PF-10a scores were collected at the preoperative and 1-year postoperative timepoints, and the change was used to determine failure to achieve the 1-year MCID. Demographic and surgical variables were also collected. The association between BMI and failure to achieve 1-year PROMIS PF-10 MCID was then evaluated using logistic regression. A BMI threshold was determined using receiver operating characteristic (ROC) curve analysis. RESULTS Increasing BMI assessed continuously was a significant risk factor for failure to achieve the MCID (P < .001). "Obese Class I" (30-35 kg/m2), "Obese Class II" (35-40 kg/m2), and "Obese Class III" (>40 kg/m2) subgroups compared to "Normal BMI" (<25 kg/m2) were significantly associated (P < .05) with this adverse outcome as well. CONCLUSION Our study showed that increasing BMI is a risk factor for failure to achieve the 1-year PROMIS PF-10a MCID following TJA. Among our patients, an increase in 1 kg/m2 increased the risk of failure to achieve the MCID by 2%. With these findings, surgeons will be better equipped to preoperatively advise patients with elevated BMIs considering TJA.
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Affiliation(s)
- Akhil Katakam
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Austin K Collins
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nicholas Sauder
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Shin
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Charles R Bragdon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA
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Felice Tong YY, Karunaratne S, Youlden D, Gupta S. The Impact of Room-Sharing on Length of Stay After Total Hip or Knee Arthroplasty: A Retrospective Study. Arthroplast Today 2021; 8:289-294.e2. [PMID: 34095406 PMCID: PMC8167312 DOI: 10.1016/j.artd.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/24/2022] Open
Abstract
Background Prolonged length of stay (LOS) after elective total hip (THA) and knee (TKA) arthroplasty is often associated with worse patient outcomes. Social support through room-sharing has been identified as a factor that may reduce LOS in a hospital setting, but has not yet been examined in an orthopedic population. The aim of this study was to evaluate the effect of single- vs shared-room accommodation after elective TKA or THA on hospital LOS. Method A retrospective study was conducted using data from hospital medical records at our institution. Patients receiving unilateral, elective THA or TKA over a 2-year period were eligible. Patients were allocated to either a single room or four-bed shared room. The primary outcome was LOS; secondary outcomes included complications, discharge destination, and return to operating theater. Results One hundred eighty-five patients (70 THA, 115 TKA; mean age 65.74 ± 10.38, 59% female) were included, of whom 82 were allocated to a single room and 103 to a shared room. There was no statistically significant difference in LOS between the 2 groups (5.18 ± 2.21 days [single] vs 4.88 ± 2.12 days [shared]; mean difference −0.29 [95% CI −0.92-0.33], P = .36). Analysis modeling for multiple confounders found no association among room allocation, LOS, and discharge destination. However, more patients in single rooms required discharge to rehabilitation (27% vs 9%) and return to theater (7% vs 1%). Conclusions Room allocation did not correlate with a difference in LOS in patients undergoing elective THA or TKA.
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Affiliation(s)
- Yui Yee Felice Tong
- Sydney Medical Program, University of Sydney, Camperdown, New South Wales, Australia.,Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sascha Karunaratne
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Daniel Youlden
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Sanjeev Gupta
- Department of Orthopaedics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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León-Muñoz VJ, López-López M, Martínez-Martínez F, Santonja-Medina F. Impact of surgical instrumentation on hospital length of stay and cost of total knee arthroplasty. Expert Rev Pharmacoecon Outcomes Res 2020; 21:299-305. [PMID: 32564699 DOI: 10.1080/14737167.2020.1778468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND We aimed to analyze the impact of two different types of surgical instrumentation (conventional manual instrumentation (CI) and patient-specific instrumentation (PSI)) on length of stay (LOS) and objectify differences in cost. We hypothesized that there are no differences in the LOS and cost due to the instrumentation system used. RESEARCH DESIGN AND METHODS LOS was registered using inpatient admission data provided by the Institutional Management Control Department. We recorded the costs associated with each procedure that could be influenced by the use of one system or another during the in-hospital stay. We conducted a prospectively single-center cohort study of 305 TKAs. Surgery was performed with conventional CI in 122 cases and with PSI in 183 cases. RESULTS The mean LOS for the CI group was 4.29 days (SD 1.65) and 4.22 days (SD 1.26), for the PSI group. No significant difference among both instrumentation systems was obtained. When comparing global costs, the mean cost was slightly higher (without a significant difference) for the PSI cases (€3110.24 vs. €2852.7 for the CI cases). CONCLUSIONS LOS and overall cost, in hospitals with a low annual TKA surgery volume, are unrelated to conventional or patient-specific instrumentation.
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Affiliation(s)
- Vicente J León-Muñoz
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mirian López-López
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Murcia, Spain
| | - Francisco Martínez-Martínez
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Faculty of Medicine, University of Murcia, Murcia, Spain
| | - Fernando Santonja-Medina
- Department of Orthopedics and Traumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Faculty of Medicine, University of Murcia, Murcia, Spain
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Berg U, W-Dahl A, Rolfson O, Nauclér E, Sundberg M, Nilsdotter A. Influence of fast-track programs on patient-reported outcomes in total hip and knee replacement (THR/TKR) at Swedish hospitals 2011-2015: an observational study including 51,169 THR and 8,393 TKR operations. Acta Orthop 2020; 91:306-312. [PMID: 32106731 PMCID: PMC8023888 DOI: 10.1080/17453674.2020.1733375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Fast-track care programs have been broadly introduced at Swedish hospitals in elective total hip and knee replacement (THR/TKR). We studied the influence of fast-track programs on patient-reported outcomes (PROs) 1 year after surgery, by exploring outcome measures registered in the Swedish arthroplasty registers.Patients and methods - Data were obtained from the Swedish Knee and Hip Arthroplasty Registers and included TKR and THR operations 2011-2015 on patients with osteoarthritis. Based on questionnaires concerning the clinical pathway and care programs at Swedish hospitals, the patients were divided in 2 groups depending on whether they had been operated in a fast-track program or not. PROs of the fast-track group were compared with not fast-track using regression analysis. EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS were analyzed for both THR and TKR operations. The PROMs for TKR also included KOOS.Results - The differences of EQ-5D, EQ VAS, Pain VAS, and Satisfaction VAS 1 year after surgery were small but all in favor of fast-track for both THR and TKR, also in subscales of KOOS for TKR except KOOS QoL. However, the effect sizes as measured by Cohens' d formula were < 0.2 for all PROs, in both THR and TKR.Interpretation - Our results indicate that the fast-track programs may be at least as good as conventional care from the perspective of PROs 1-year postoperatively.
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Surgery and Orthopaedics, Kungälv Hospital; ,Correspondence:
| | - Annette W-Dahl
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Ola Rolfson
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital; ,The Swedish Hip Arthroplasty Register, Sweden
| | | | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences Lund, Lund University; ,The Swedish Knee Arthroplasty Register;
| | - Anna Nilsdotter
- Department of Orthopaedics, Clinical Sciences, Sahlgrenska Academy, Gothenburg University; ,Department of Orthopedics Sahlgrenska University Hospital;
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Xu H, Xie J, Yang J, Chen G, Huang Q, Pei F. Plasma Fibrinogen and Platelet Count Are Referable Tools for Diagnosing Periprosthetic Joint Infection: A Single-Center Retrospective Cohort Study. J Arthroplasty 2020; 35:1361-1367. [PMID: 31899088 DOI: 10.1016/j.arth.2019.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the MusculoSkeletal Infection Society has suggested a series of markers to diagnose periprosthetic joint infection (PJI), no single marker can accurately identify infection before revision hip or knee arthroplasty, and exploring promising markers to easily and reliably diagnose PJI is ongoing. The aim of this study was to evaluate the diagnostic value of plasma fibrinogen and platelet count for diagnosing PJI. METHODS We retrospectively included 439 patients who underwent revision arthroplasty from January 2008 to December 2018; 79 patients with coagulation-related comorbidities were evaluated separately. The remaining 360 patients constituted 153 PJI and 207 non-PJI patients. Receiver operating characteristic curves were used to evaluate the maximum sensitivity and specificity of the tested markers. RESULTS The receiver operating characteristic curves showed that the areas under the curve for plasma fibrinogen, platelet count, and serum C-reactive protein and erythrocyte sedimentation rate were 0.834, 0.746, 0.887, and 0.842, respectively. Based on Youden's index, the optimal predictive cutoffs for fibrinogen and platelet count were 3.57 g/L and 221 × 109/L, respectively. The sensitivity and specificity, respectively, were 68.6% and 86.0% (fibrinogen) and 57.5% and 83.1% (platelet count) for diagnosing PJI. The sensitivity and specificity, respectively, were 76.7% and 72.2% (fibrinogen) and 48.8% and 63.9% (platelet count) for diagnosing PJI in patients with coagulation-related comorbidities. CONCLUSION Plasma fibrinogen performed well for diagnosing PJI before revision arthroplasty, and its value neared that of traditional inflammatory markers. Although the diagnostic value of the platelet count was inferior to traditional markers, its diagnostic value was fair for diagnosing PJI. Fibrinogen also may be useful for diagnosing PJI in patients with coagulation-related comorbidities.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jingli Yang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Guo Chen
- Department of Orthopedics, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, People's Republic of China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Leroux TS, Maldonado-Rodriguez N, Paterson JM, Aktar S, Gandhi R, Ravi B. No Difference in Outcomes Between Short and Longer-Stay Total Joint Arthroplasty with a Discharge Home: A Propensity Score-Matched Analysis Involving 46,660 Patients. J Bone Joint Surg Am 2020; 102:495-502. [PMID: 31703047 DOI: 10.2106/jbjs.19.00796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) with a short length of hospital stay have been reported; however, most studies have not accounted for an inherent patient selection bias and discharge disposition. The purpose of this study was to utilize a propensity score to match and compare the outcomes of patients undergoing THA or TKA with short and longer lengths of stay with a discharge directly home. METHODS An administrative database from Ontario, Canada, which has a single-payer health-care system, was retrospectively reviewed to identify patients who underwent THA or TKA from 2008 to 2016. Patients were subsequently stratified into 2 groups based on their length of stay: short length of stay (≤2 days; thereafter referred to as short stay) and longer length of stay (>2 days; thereafter referred to as longer stay). Using a propensity score, patients who underwent short-stay THA or TKA were matched to patients who underwent longer-stay THA or TKA. Matching was based on 15 demographic, medical, and surgical factors. Our primary outcomes included postoperative complications, health-care utilization (readmission and emergency department presentation), and health-care costs. RESULTS Overall, 89,656 TKAs (14,645 short stays and 75,011 longer stays) and 52,610 THAs (9,426 short stays and 43,184 longer stays) were included in this study. Patients who underwent short-stay THA or TKA were significantly more likely (p < 0.05) to be younger, male, healthier, and from a higher socioeconomic status and to have undergone the procedure with a higher-volume surgeon. Over 95% of short-stay cases were successfully matched to longer-stay cases, and we found no significant difference in complications, health-care utilization, and costs between patients on the basis of the length of stay. CONCLUSIONS Patients undergoing short-stay THA or TKA with a discharge home were more likely to be younger, healthy, male patients from a higher socioeconomic status. Higher-volume surgeons are also more likely to perform short-stay THA or TKA. These characteristics confirm the previously held belief that a selection bias exists when comparing cohorts based on time to discharge. When comparing matched cohorts of patients who underwent short-stay and longer-stay THA or TKA, we observed no difference in outcomes, suggesting that a short stay with a discharge home in the appropriately selected patient is safe following THA or TKA. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Timothy S Leroux
- The Arthritis Program, University Health Network, Toronto, Ontario, Canada
| | | | - J Michael Paterson
- The Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Suriya Aktar
- The Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
| | - Rajiv Gandhi
- The Arthritis Program, University Health Network, Toronto, Ontario, Canada
| | - Bheeshma Ravi
- The Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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12
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Ding ZC, Xu B, Liang ZM, Wang HY, Luo ZY, Zhou ZK. Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery. Orthop Surg 2019; 12:153-161. [PMID: 31885219 PMCID: PMC7031546 DOI: 10.1111/os.12600] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives To identify predictors of length of stay (LOS) after total hip arthroplasty (THA) in an enhanced recovery after surgery (ERAS) program and evaluate the safety and cost‐efficiency of the ERAS program with reduced LOS for unselected patients in a Chinese population. Methods A total of 311 consecutive, unselected patients undergoing primary THA at a single institution were retrospectively reviewed and divided into two groups: LOS ≤ 3 and LOS > 3 group. All patients were managed with the same ERAS protocol and went back home after discharge. Multivariate logistic regression analysis was used to determine independent risk factors for LOS > 3. Harris Hip Score at 90‐day follow‐up, 90‐day readmission rate, and hospitalization costs were compared between two groups. Results Multivariate regression analysis identified female gender (odds ratio [OR] = 2.623), living alone (OR = 4.127), and primary osteoarthritis of hip (OR = 3.565) to be correlated with LOS > 3. Preoperative hemoglobin (HB), postoperative HB, drain use, blood transfusion, diabetes, respiratory disease, osteoporosis, number of comorbidities, and CCI score showed no significant influence on LOS after adjusting for other risk factors in the multivariate model. Harris Hip Score and readmission rate at 90‐day follow‐up showed no significant differences between two groups. Patients in LOS > 3 group had approximately 3948.6 Chinese yuan higher hospital costs. Conclusion Female gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for prolonged LOS. The experience from our institution suggested aggressive management of comorbidities in the ERAS program can minimize the influence of comorbidities on LOS. The safety, efficiency, and costs‐saving benefits of the ERAS program with reduced LOS for unselected patients was confirmed in this study.
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Affiliation(s)
- Zi-Chuan Ding
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Bing Xu
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, China
| | - Zhi-Min Liang
- Clinic Research Management Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hao-Yang Wang
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ze-Yu Luo
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Zong-Ke Zhou
- Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Xu H, Xie J, Lei Y, Huang Q, Huang Z, Pei F. Closed suction drainage following routine primary total joint arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a retrospective cohort study. J Orthop Surg Res 2019; 14:163. [PMID: 31142376 PMCID: PMC6542095 DOI: 10.1186/s13018-019-1211-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In an enhanced recovery after surgery program, not placing a closed suction drain following routine primary total joint arthroplasty (TJA) is becoming more acceptable. However, the influence of drain use on transfusion rate and postoperative length of stay (PLOS) in TJA remains controversial. Therefore, we aimed to compare drain use with no drain in routine primary TJA to determine the differences in transfusion rate and PLOS. METHODS We analyzed the data from 12,992 patients undergoing primary unilateral TJA: 6325 total knee arthroplasties (TKA) and 6667 total hip arthroplasties (THA). Patients were divided into two groups according to whether they received a drain postoperatively following TKA and THA. We extracted information for transfusion and PLOS from patients' electronic health records and analyzed the data by logistic and linear regression analyses. RESULTS The transfusion rate and PLOS were 15.07% and 7.75 ± 3.61 days, respectively, in the drain group and 6.72% and 6.54 ± 3.32 days, respectively, in the no-drain group following TKA. The transfusion rate and PLOS were 20.53% and 7.00 ± 3.35 days, respectively, in the drain group and 13.57% and 6.07 ± 3.06 days, respectively, in the no-drain group following THA. After adjusting for the following variables: age, gender, body mass index, orthopedic diagnoses, hypertension, type 2 diabetes, coronary heart disease, chronic obstructive pulmonary disease, preoperative hemoglobin, albumin, analgesic use, anesthesia, American Society of Anesthesiologists class, tranexamic acid use, intraoperative bleeding, operative time, and tourniquet use (for TKA), drain use correlated significantly with a higher transfusion rate (risk ratio = 2.812, 95% confidence interval (CI) 2.224-3.554, P < 0.001 for TKA and risk ratio = 1.872, 95% CI 1.588-2.207, P < 0.001 for THA) and a longer PLOS (partial regression coefficient (B) = 1.099, 95% CI 0.879-1.318, P < 0.001, standard regression coefficient (B') = 0.139 for TKA; B = 0.973, 95% CI 0.695-1.051, P < 0.001, and B' = 0.115 for THA). Two groups showed no significant difference in wound complications. CONCLUSIONS Our findings indicated that drain use was associated with a higher transfusion rate and a longer PLOS in patients undergoing routine primary TJA. The routine use of postoperative drainage is not recommended in primary unilateral TJA.
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Affiliation(s)
- Hong Xu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Jinwei Xie
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Yiting Lei
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Qiang Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Zeyu Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
| | - Fuxing Pei
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
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14
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Taniguchi M, Hiyama Y, Kamitani T, Kubo M, Kawasaki T, Wada O, Mizuno K, Matsusue Y. Comparison of recovery of mobility and self-efficacy after total knee arthroplasty based on two different protocols: A prospective cohort study. Mod Rheumatol 2019; 30:197-203. [DOI: 10.1080/14397595.2018.1553228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinori Hiyama
- Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiko Kubo
- Department of Orthopedic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Taku Kawasaki
- Department of Orthopedic Surgery, Shiga University of Medical Science, Shiga, Japan
| | | | | | - Yoshitaka Matsusue
- Department of Orthopedic Surgery, Shiga University of Medical Science, Shiga, Japan
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Berg U, BüLow E, Sundberg M, Rolfson O. No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: An observational before-and-after study of 14,148 total joint replacements 2011-2015. Acta Orthop 2018; 89:522-527. [PMID: 29985681 PMCID: PMC6202734 DOI: 10.1080/17453674.2018.1492507] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and purpose - Fast-track care programs in elective total hip and knee replacement (THR/TKR) have been introduced in several countries during the last decade resulting in a significant reduction of hospital stay without any rise in readmissions or early adverse events (AE). We evaluated the risk of readmissions and AE within 30 and 90 days after surgery when a fast-track program was introduced in routine care of joint replacement at 8 Swedish hospitals. Patients and methods - Fast-track care programs were introduced at 8 public hospitals in Västra Götaland region from 2012 to 2014. We obtained data from the Swedish Hip and Knee Arthroplasty Registers for patients operated with THR and TKR in 2011-2015. All readmissions and new contacts with the health care system within 3 months with a possible connection to the surgical intervention were requested from the regional patient register. We compared patients operated before and after the introduction of the fast-track program. Results - Implementation of the fast-track program resulted in a decrease in median hospital length of stay (LOS) from 5 to 3 days in both THR and TKR. The total readmission rate <90 days for THR was 7.2% with fast-track compared with 6.7% in the previous program, and for TKR 8.4% in both groups. Almost half of the readmissions occurred without any AE identified. There was no statistically significant difference concerning readmissions or AE when comparing the programs. Interpretation - Implementation of a fast-track care program in routine care of elective hip and knee replacement is effective in reducing hospital stay without increasing the risk of readmissions or adverse events within 90 days after surgery.
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MESH Headings
- Aged
- Aged, 80 and over
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Critical Pathways/organization & administration
- Female
- Hospitalization/statistics & numerical data
- Humans
- Length of Stay/statistics & numerical data
- Male
- Middle Aged
- Patient Readmission/statistics & numerical data
- Postoperative Complications/epidemiology
- Registries
- Sweden/epidemiology
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Affiliation(s)
- Urban Berg
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg;
- Department of Surgery and Orthopaedics, Kungälv Hospital;
- Correspondence:
| | - Erik BüLow
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg;
- The Swedish Hip Arthroplasty Register;
| | - Martin Sundberg
- Department of Orthopedics, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden;
- The Swedish Knee Arthroplasty Register
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg;
- The Swedish Hip Arthroplasty Register;
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Zhang S, Huang Q, Xie J, Xu B, Cao G, Pei F. Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty. J Orthop Surg Res 2018; 13:29. [PMID: 29394902 PMCID: PMC5797406 DOI: 10.1186/s13018-018-0729-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 01/23/2018] [Indexed: 02/05/2023] Open
Abstract
Background Hospital length of stay (LOS) after primary total knee arthroplasty (TKA) has decreased obviously following the implementation of enhanced recovery after surgery (ERAS) program in the last few years. However, there are still some patients that cannot be discharged at early time for a variety of reasons, and it is necessary to explore factors leading to prolonged LOS. Therefore, the purpose of this study was to identify the complete preoperative, perioperative, and postoperative factors associated with prolonged postoperative LOS (PLOS) after primary TKA in a detailed ERAS program. Methods In a consecutive series from July 2015 to March 2017, all patients who underwent unilateral elective primary TKA were included in the retrospective study. A PLOS greater than 3 days was considered a prolonged PLOS. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant preoperative, perioperative, and postoperative variables that were associated with prolonged PLOS and postoperative complications. Results A total of 241 patients were included with a mean PLOS of 3.8 days. Prolonged PLOS was significantly associated with preoperative valgus deformity of the knee (OR 4.95, 95%CI 1.56–15.77, P = 0.007), increased serum level of interleukin-6 on postoperative day 1 (OR 1.01, 95%CI 1.00–1.03, P = 0.039), increased visual analogue scale pain score and serum level of C-reactive protein on postoperative day 3 (OR 2.56, 95%CI 1.28–5.13, P = 0.008; OR 1.01, 95%CI 1.00–1.03, P = 0.019), increased day to achieve 90° active knee flexion after surgery (OR 2.19, 95%CI 1.27–3.79, P = 0.005), and postoperative wound complications (OR 8.58, 95%CI 2.10–35.03, P = 0.003) and other minor complications (OR 6.04, 95%CI 2.40–15.19, P < 0.001). Preoperative pulmonary infection (OR 2.75, 95%CI 1.20–6.28, P = 0.016), American Society of Anesthesiologists score 3/4 (OR 2.14, 95%CI 1.01–4.52, P = 0.046), and utilization of catheter after surgery (OR 2.53, 95%CI 1.23–5.19, P = 0.012) were significantly associated with postoperative complications. Conclusions Multiple factors were associated with prolonged PLOS and postoperative complications after TKA in the ERAS program. It is important to recognize all the factors to try to maximize the use of medical resources and ultimately optimize the care of our patients.
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Affiliation(s)
- Shaoyun Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qiang Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jinwei Xie
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bin Xu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Guorui Cao
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Fuxing Pei
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Day of Surgery Affects Length of Stay and Charges in Primary Total Hip and Knee Arthroplasty. J Arthroplasty 2017; 32:11-15. [PMID: 27471211 DOI: 10.1016/j.arth.2016.06.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Length of hospital stay (LOS) is a large driver of cost after primary total joint arthroplasty (TJA). Strategies to decrease LOS may help reduce the economic burden of TJA. This study's aim was to investigate the effect of day of the week of surgery on mean LOS and total charges following primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS An administrative clinical database at a large US health care system was reviewed for all primary THA and TKA admissions performed between 2010 and 2012 (n = 15,237). Of these, 14,800 cases met our inclusion criteria and were analyzed. Furthermore, the cohort was divided into early (Monday/Tuesday) and late week (Thursday/Friday) surgeries, excluding Wednesday surgeries (n = 2835). Univariate and multiple regression analyses examined the effect of each variable on LOS. RESULTS Mean LOS for THA and TKA on Monday was 3.54 and 3.35 days and increased to 4.12 and 3.66 days on Friday (P < .0001), respectively. Late vs early week admissions had 0.358 (95% confidence interval: 0.29-0.425, P < .001) additional hospital days. Increased age (0.003 days per unit increase in age, P = .02) and severity of illness score (0.781 days per level increase, P < .001) were associated with increased LOS. Late week surgery had a greater effect on LOS for TKA than for THA. TKAs were associated with higher charges for late week surgery vs early week surgery (P < .001). CONCLUSION Late week TJA cases, older age, and increasing severity of illness score were associated with increased LOS. Furthermore, late week TKA was associated with increased total charges.
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