Dataset Information

Prolonged length of stay (PLOS) in a high-volume arthroplasty unit.

ABSTRACT: Introduction:The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative length of stay in recent years. Patients with prolonged length of stay (PLOS) add to the burden of a strained NHS. Our aim was to identify the main reasons. Methods:A PLOS was arbitrarily defined as an inpatient hospital stay of four days or longer from admission date. A total of 2,000 consecutive arthroplasty patients between September 2017 and July 2018 were reviewed. Of these, 1,878 patients were included after exclusion criteria were applied. Notes for 524 PLOS patients were audited to determine predominant reasons for PLOS. Results:The mean total length of stay was 4 days (1 to 42). The top three reasons for PLOS were social services, day-before-surgery admission, and slow to mobilize. Social services accounted for 1,224 excess bed days, almost half (49.2%, 1,224/2,489) of the sum of excess bed days. Conclusion:A preadmission discharge plan, plus day of surgery admission and mobilization on the day of surgery, would have the potential to significantly reduce length of stay without compromising patient care.Cite this article: Bone Joint Open 2020;1-8:488-493.

SUBMITTER: Kang HW

PROVIDER: S-EPMC7659636 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Prolonged length of stay (PLOS) in a high-volume arthroplasty unit.

Kang Hean Wu HW Bryce Leeann L Cassidy Roslyn R Hill Janet Catherine JC Diamond Owen O Beverland David D

Bone & joint open 20200818 8

<h4>Introduction</h4>The enhanced recovery after surgery (ERAS) concept in arthroplasty surgery has led to a reduction in postoperative length of stay in recent years. Patients with prolonged length of stay (PLOS) add to the burden of a strained NHS. Our aim was to identify the main reasons.<h4>Methods</h4>A PLOS was arbitrarily defined as an inpatient hospital stay of four days or longer from admission date. A total of 2,000 consecutive arthroplasty patients between September 2017 and July 2018 ...[more]

PMID: 33215143

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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.

Dataset Information

Prolonged length of stay (PLOS) in a high-volume arthroplasty unit.

Publications

Prolonged length of stay (PLOS) in a high-volume arthroplasty unit.

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