Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China.
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ABSTRACT:
SUBMITTER: Song X
PROVIDER: S-EPMC6995082 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
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Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China.
Song Xiaoxiao X Xia Caiwei C Li Qiangqiang Q Yao Chen C Yao Yao Y Chen Dongyang D Jiang Qing Q
BMC musculoskeletal disorders 20200131 1
<h4>Background</h4>Decreasing the length of hospital stay is an ideal course of action to appropriately allocate medical resources. The aim of this retrospective study was to identify perioperative factors that may decrease the length of hospital stay (LOS).<h4>Methods</h4>In this study, we collected the data on 1112 patients who underwent primary total knee arthroplasty surgery (TKAs) at our institution from Jan 1, 2011 to Nov 31, 2017. Based on the published literature, 16 potential factors (1 ...[more]
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Project description:PurposeTo identify factors that independently predict extended length of stay after unicompartmental knee arthroplasty (UKA) surgery (defined as length of stay longer than 3 days), and to identify factors predicting early post-operative complications.MethodsA retrospective analysis of all patients undergoing UKA from January 2016-January 2019 at our institution was performed. Clinical notes were reviewed to determine the following information: Patient age (years), gender, American Society of Anesthesiologists (ASA) grade, weight (kg), height (meters), body mass index (BMI), co-morbidities, indication for surgery, surgeon, surgical volume, surgical technique (navigated or patient-specific instrumentation), implant manufacturer, estimated blood loss (ml), application of tourniquet during the surgery, application of drain, hospital length of stay (days) and surgical complications.ResultsMultivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 4.4 (CI; 1.8-10.8, p = 0.001)] and a history of cardiovascular disease [OR 2.8 (CI; 1.4-5.5), p = 0.004)] were significant independent predictors of prolonged length of stay. Hosmer-Lemeshow goodness of fit of the model showed a p-value of 0.214. Nagelkerke R-Square was 0.2. For complications, multivariate regression analysis showed that ASA 3-4 vs. ASA 1-2 [OR 5.8 (CI; 1.7-20.7)] and high BMI (BMI >30) [OR 4.3 (CI; 1.1-17.1)] were significant independent predictors of complications. Hosmer-Lemeshow goodness of fit was 0.89 and Nagelkerke R-Square was 0.2. Patients treated with robotics (Navio) techniques had shorter length of stay median 51 h (IQR; 29-96) when compared to other techniques 72 h (IQR; 52-96), p = 0.008.ConclusionBased on the results of our study, high ASA grade (≥3) appears to be the most important factor excluding eligibility for fast-track UKA. Any number of co-morbidities may increase ASA, but in and of themselves, apart from a history of cardiovascular disease, they should not be seen as contraindications. Appropriate patient selection, technical tools and details during the surgery could facilitate fast track surgery.
| S-EPMC7067998 | biostudies-literature
Project description:BackgroundIncreasing national expenditures and use associated with TKA have resulted in pressure to reduce costs through various reimbursement cuts. However, within the arthroplasty literature, few studies have examined the association of medical comorbidities on resource use and length of stay after joint arthroplasty.Questions/purposesThe purpose of this study was to examine the association between individual patient characteristics (including demographic factors and medical comorbidities) on resource allocation and length of stay (LOS) after TKA.MethodsWe queried the 2009 Nationwide Inpatient Sample dataset for International Classification of Diseases, 9(th) Revision code, 81.54, for TKAs. An initial 621,029-patient cohort was narrowed to 516,745 after inclusion of elective TKAs on patients aged between 40 and 95 years. Using generalized linear models, we estimated the effect of comorbidities on resource use (using cost-to-charge conversions to estimate hospital costs) and the LOS controlling for patient and hospital characteristics. Across the 2009 national cohort with TKAs, 12.7% had no comorbidities, whereas 32.6% had three or more. The most common conditions included hypertension (67.8%), diabetes (20.0%), and obesity (19.8%). Mean hospital costs were USD 14,491 (95% confidence interval [CI], 14,455-14,525) and mean hospital LOS was 3.3 days (95% CI, 3.29-3.31) in this data set.ResultsPatients with multiple comorbidities were associated with increased resource use and LOS. Higher marginal costs and LOS were associated with patients who had an inpatient death (USD +8017 [95% CI, 8006-8028], +2.3 [CI, 2.15-2.44] days over baseline), patients with recent weight loss (USD +4587 [95% CI, 4581-4593], +1.5 [CI, 1.45-1.61) days], minority race (USD +1037 [95% CI, 1035-1038], +0.3 [CI, 0.28-0.33] days), pulmonary-circulatory disorders (USD +3218 [95% CI, 3214-3221], +1.3 [CI, 1.25-1.34] days), and electrolyte disturbances (USD +1313 [95% CI, 1312-1314], +0.6 [CI, 0.57-0.60] days). All p values were < 0.001.ConclusionMultiple patient comorbidities were associated with additive resource use and LOS after TKA. Current reimbursement may not adequately account for these patient characteristics. To avoid potential loss of access to care for sicker patients, payment needs to be adjusted to reflect actual resource use.Level of evidenceLevel IV, economic and decision analysis. See the Instructions for Authors for a complete description of levels of evidence.
| S-EPMC4397785 | biostudies-literature
Project description:ObjectiveThis study explored the risk factors influencing the length of hospital stay (LOS) and establish whether the type of anesthesia is independently associated with the LOS in patients after primary unilateral total knee arthroplasty (TKA).MethodsIn this retrospective cohort study, 2309 patients undergoing unilateral TKA were recruited between January 2013 and June 2014 in a tertiary academic medical center in Singapore. Univariate and multivariate linear regression analyses were used to identify the independent risk factors associated with LOS. Besides, subgroup and interaction analyses were performed to evaluate the relationship between the type of anesthesia and LOS.ResultIn total, 2309 patients were identified. Out of these, 791 patients underwent general anesthesia, whereas 1518 patients underwent regional anesthesia. Multivariate regression analyses revealed that prolonged LOS was significantly associated with age ≥ 65 years (β = 0.48; 95% CI, 0.09-0.87; P = 0.015), diabetes mellitus (DM) (β = 0.8; 95% CI, 0.33-1.27; P = 0.001), congestive cardiac failure (CCF) (β = 4.1; 95% CI, 2.02-6.17; P < 0.001), perioperative blood transfusion (β = 5.71; 95% CI, 4.86-6.56; P < 0.001), creatinine > 2 mg/dL (β = 4.54; 95% CI, 2.46-6.62; P < 0.001), ASA status (III) (β = 1.72; 95% CI, 0.72-2.71; P = 0.001), general anesthesia (β = 0.78; 95% CI, 0.41-1.66; P < 0.001). The LOS further decreased among participants receiving regional anesthesia at advanced age (age ≥ 65 years) (β = - 1.12; 95% CI, - 1.66 to - 0.58; P < 0.001), patients with BMI ≤ 25 kg/m2 (β = - 1.92; 95% CI, - 2.73 to - 1.11; P < 0.001) or ≥ 30 kg/m2 (β = - 0.58; 95% CI, - 1.1 to - 0.06; P = 0.029).ConclusionOur findings demonstrated that age ≥ 65 years, DM, CCF, perioperative blood transfusion, creatinine > 2 mg/dL, ASA status (III), general anesthesia are associated with a prolonged LOS after primary TKA. Elderly patients (age ≥ 65 years) and patients with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2 receiving regional anesthesia have a further reduced LOS. Therefore, when TKA is performed, priority for regional anesthesia is given to the elderly patients (age ≥ 65 years old) and those with BMI ≤ 25 kg/m2 or ≥ 30 kg/m2.
| S-EPMC8591843 | biostudies-literature
Project description:ObjectivesThe aim of this study was to compare the impact of fast-track rehabilitation (FTR) and conventional rehabilitation (CR) on early recovery pattern after fast-track surgery for knee arthroplasty and conventional total knee arthroplasty (TKA).Patients and methodsThis prospective, case-control study included a total of 43 adult patients (10 males, 33 females; mean age 69 years; range, 50 to 82 years) who were clinically stable and admitted for rehabilitation after fast-track surgery for knee arthroplasty or conventional TKA January 2016 and August 2016. The patients were divided into two groups as the FTR and CR treatment groups. The FTR program was designed as a patient-focused care, early mobilization, and standardized postoperative milestones. The CR program was designed by standard postoperative rehabilitation care. Primary outcomes were the length of stay (LOS) in the hospital and knee function. Secondary outcomes were pain and activities of daily living.ResultsAt baseline, both groups were similar in terms of demographic data and primary outcomes. At discharge, intra-group analysis showed significant differences in both groups in all functional outcomes, except for pain, while the inter-group LOS was also significantly different (p<0.001).ConclusionOur study results indicate that LOS can be reduced by FTR, yielding the same results in functional recovery and autonomy as CR.
| S-EPMC7756836 | biostudies-literature
Project description:Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are cost-effective procedures that decrease pain and improve health-related quality of life for patients with advanced symptomatic arthritis, including rheumatoid arthritis (RA). Patients with RA have a longer length of stay (LOS) after THA or TKA than patients with osteoarthritis, yet the factors contributing to LOS have not been investigated. Purpose: We sought to identify the factors contributing to LOS for patients with RA undergoing THA and TKA at a single tertiary care orthopedic specialty hospital. Methods: We retrospectively reviewed data from a prospectively collected cohort of 252 RA patients undergoing either THA or TKA. Demographics, RA characteristics, medications, serologies, and disease activity were collected preoperatively. Linear regression was performed to explore the relationship between LOS (log-transformed) and possible predictors. A multivariate model was constructed through backward selection using significant predictors from a univariate analysis. Results: Of the 252 patients with RA, 83% were women; they had a median disease duration of 14 years and moderate disease activity at the time of arthroplasty. We had LOS data on 240 (95%) of the cases. The mean LOS was 3.4 ± 1.5 days. The multivariate analysis revealed a longer LOS for RA patients who underwent TKA versus THA, were women versus men, required a blood transfusion, and took preoperative opioids. Conclusion: Our retrospective study found that increased postoperative LOS in RA patients undergoing THA or TKA was associated with factors both non-modifiable (type of surgery, sex) and modifiable (postoperative blood transfusion, preoperative opioid use). These findings suggest that preoperative optimization of the patient with RA might focus on improving anemia and reducing opioid use in efforts to shorten LOS. More rigorous study is warranted.
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Project description:BackgroundThe length of in-hospital stay (LOS) is an important measure of efficiency in the use of hospital resources and care quality outcomes after orthopaedic surgery. This study investigated the influence of patients' characteristics including demographic factors and the presence of comorbid preoperative depression on LOS after primary total knee arthroplasty (TKA).MethodsData were extracted from the California Healthcare Cost and Utilization Project database for hospital discharges after primary TKA for adults aged 50 years and older from 2007 to 2010 (n = 133,603). LOS was defined as the difference in days between the date of admission and the date of discharge. We included demographic data (age, sex, race), comorbidity of depression, and years of admission as covariates in the multivariable model. Negative binomial regression was used to model the effect(s) of covariates on the LOS. As a secondary analysis, the association of covariates with the extended LOS (>9 days) was also investigated using logistic regression.ResultsOur study showed that female sex, age, Medicaid insurance, and race were associated with a longer LOS. Most importantly, a diagnosis of depression was associated with a significantly longer LOS (1.05 times longer: 95% CI: 1.04-1.06) and was independently associated with 1.83 times higher odds (95% CI: 1.50-2.23) of belonging to the extended LOS group. Compared to 2007, significant reductions of both LOS and a longer LOS were noted throughout all later years from 2008 to 2010.ConclusionsOur study revealed that a diagnosis of depression and patient's characteristic such as age, female sex, Medicaid, nonwhite race resulted in a statistically significant increased LOS. These findings can be useful for planning and resource allocation for total knee replacement programs.
| S-EPMC7083721 | biostudies-literature
Project description:BackgroundThe length of in-hospital stay (LOS) is an important measure of efficiency in the use of hospital resources and care quality outcomes after orthopaedic surgery. This study investigated the influence of patients' characteristics including demographic factors and the presence of comorbid preoperative depression on LOS after primary total knee arthroplasty (TKA).MethodsData were extracted from the California Healthcare Cost and Utilization Project database for hospital discharges after primary TKA for adults aged 50 years and older from 2007 to 2010 (n = 133,603). LOS was defined as the difference in days between the date of admission and the date of discharge. We included demographic data (age, sex, race), comorbidity of depression, and years of admission as covariates in the multivariable model. Negative binomial regression was used to model the effect(s) of covariates on the LOS. As a secondary analysis, the association of covariates with the extended LOS (>9 days) was also investigated using logistic regression.ResultsOur study showed that female sex, age, Medicaid insurance, and race were associated with a longer LOS. Most importantly, a diagnosis of depression was associated with a significantly longer LOS (1.05 times longer: 95% CI: 1.04-1.06) and was independently associated with 1.83 times higher odds (95% CI: 1.50-2.23) of belonging to the extended LOS group. Compared to 2007, significant reductions of both LOS and a longer LOS were noted throughout all later years from 2008 to 2010.ConclusionsOur study revealed that a diagnosis of depression and patient's characteristic such as age, female sex, Medicaid, nonwhite race resulted in a statistically significant increased LOS. These findings can be useful for planning and resource allocation for total knee replacement programs.
| S-EPMC7083721 | biostudies-literature
Project description:BackgroundThe length of in-hospital stay (LOS) is an important measure of efficiency in the use of hospital resources and care quality outcomes after orthopaedic surgery. This study investigated the influence of patients' characteristics including demographic factors and the presence of comorbid preoperative depression on LOS after primary total knee arthroplasty (TKA).MethodsData were extracted from the California Healthcare Cost and Utilization Project database for hospital discharges after primary TKA for adults aged 50 years and older from 2007 to 2010 (n = 133,603). LOS was defined as the difference in days between the date of admission and the date of discharge. We included demographic data (age, sex, race), comorbidity of depression, and years of admission as covariates in the multivariable model. Negative binomial regression was used to model the effect(s) of covariates on the LOS. As a secondary analysis, the association of covariates with the extended LOS (>9 days) was also investigated using logistic regression.ResultsOur study showed that female sex, age, Medicaid insurance, and race were associated with a longer LOS. Most importantly, a diagnosis of depression was associated with a significantly longer LOS (1.05 times longer: 95% CI: 1.04-1.06) and was independently associated with 1.83 times higher odds (95% CI: 1.50-2.23) of belonging to the extended LOS group. Compared to 2007, significant reductions of both LOS and a longer LOS were noted throughout all later years from 2008 to 2010.ConclusionsOur study revealed that a diagnosis of depression and patient's characteristic such as age, female sex, Medicaid, nonwhite race resulted in a statistically significant increased LOS. These findings can be useful for planning and resource allocation for total knee replacement programs.
| S-EPMC7083721 | biostudies-literature
Project description:IntroductionTotal knee arthroplasty (TKA) is commonly performed using tourniquet despite being associated with several recognised complications that may affect patient's post-operative recovery and early rehabilitation. In this study we investigate whether or not use of a tourniquet during TKA was associated with shorter length of stay, faster recovery and lesser complications.Methods29 patients, who underwent bilateral sequential TKA, had their first TKA under tourniquet and the second TKA 15 (11-32) months later without tourniquet.All operations were performed by the first author using the same technique and instrumentation with the same early rehabilitation protocol. All patients were followed prospectively for a minimum of 8 months.All patients had the following parameters measured which included surgical time, length of stay, post-operative pain using Visual analogue score (VAS), calf circumference, drop in haemoglobin, haematocrit level, oxford knee score (OKS), and range of motion (ROM).ResultsTKA performed without the use of tourniquet had significantly shorter Length of hospital stay (3.6 vs 4.4, P?<?0.05), significantly less pain on day 2 (1 vs 2; P?<?0.05) and significantly smaller increase in calf circumference on day 2 (1.2?cm vs 2.3?cm; P?<?0.05). Postoperative calf circumference increase of less than 2?cm in TKA without tourniquet was associated with shorter length of stay when compared with increase of more than 2?cm in TKA with tourniquet 2.9 days (SD 0.6) versus 3.9 days (SD 0.8) P?<?0.05.ROM and OKS were significantly better in TKA without tourniquet at 6 weeks but no difference at 8 months.ConclusionsTKA done without tourniquet was associated with shorter length of stay, lesser pain and swelling, in addition to improved range of motion in the early post-operative period.
| S-EPMC6985009 | biostudies-literature
Project description:ObjectiveThe aim was to evaluate whether using novel anchored barded suture for capsular closure can further shorten the length of stay following primary total knee arthroplasty (TKA) within existed enhanced recovery after surgery (ERAS) protocol in osteoarthritis patients.MethodsA retrospective cohort study was conducted among osteoarthritis patients aged 18 to 80 years without major comorbidities who underwent primary unilateral TKA between January 2018 and December 2019 was conducted. The capsular closure techniques, interventions for ERAS, operation time and length of stay were collected via hospital electronic information system. Propensity-score matching was used to compensate for the difference in interventions for ERAS and patient characteristics. Subgroup comparison of patients treated under normal ERAS protocol was performed.ResultsIncluded were 315 patients with capsular closure by barded suture and 397 patients with interrupted capsular closure by traditional suture. Patients' characteristics and interventions for ERAS were balanced after propensity-score matching. The average postoperative length of stay in barded suture group was shorter than the compared group (2.10 ± 0.57 vs. 2.33 ± 0.80 days, p = 0.004), and with a significantly higher proportion of patients discharging within 2 days post procedure (88.0% vs. 70.7%, p < 0.001). The operation time for patients with barded suture closure was shorter compared to interrupted closure technique (100.90 ± 16.59 vs. 105.52 ± 18.47 min, p = 0.004). Subgroup analysis of patients treated under different levels ERAS protocol showed comparable results.ConclusionThe use of barded suture for capsular closure was associated with shorter length of stay after TKA compared to traditional suture, suggesting that barded suturing technique could be one effective intervention for ERAS.
| S-EPMC8996641 | biostudies-literature