The Impact of Room-Sharing on Length of Stay After Total Hip or Knee Arthroplasty: A Retrospective Study.
Ontology highlight
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.
SUBMITTER: Felice Tong YY
PROVIDER: S-EPMC8167312 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BACKGROUND: The steady rise in demand for total hip arthroplasty constitutes a significant and increasing burden on health care resources. The biggest contributors to the total cost of hip replacement procedures other than the price of the implant are hospital stay and postoperative rehabilitation. Blood management is one of the most adjustable factors that can impact length of stay and cost-efficiency while improving patient safety. QUESTIONS/PURPOSES: The primary purpose of this retrospective study was to assess the potential impact of blood management interventions on length of hospital stay after primary unilateral total hip arthroplasty. This was achieved by first identifying which patient and surgical factors are associated with an increased risk of prolonged hospital stay. Subsequently, the significant factors were controlled for through a multivariate regression analysis to quantify the association between blood transfusions and increased hospital stay. METHODS: Retrospectively, the study included 2,104 primary total hip replacements. Eight hundred eighty-eight procedures were performed on males and 1,216 on females, with a mean age of 64 years at the time of the surgery (range 18-94 years) and BMI of 28.6 kg/m(2) (range 12-51.5 kg/m(2)). The correlation between each factor and length of stay was analyzed separately using univariate regression analysis. Those variables with p???0.05 in the univariate model were selected for inclusion in the multivariate logistic regressions. Multiple linear regression was used to analyze the effect of each significant factor and derive odds ratios with adjustment for the other variables. RESULTS: Multivariate Poisson regression revealed that increased length of stay was significantly correlated to patient age (p?=?0.05), the use of coumadin (p?=?0.02) or lovenox/heparin (p?=?0.007) as opposed to aspirin for anticoagulation, and allogeneic blood transfusion (p?<?0.0001). The data shows that allogeneic blood transfusion is associated with a longer hospital stay regardless of absolute drop in hemoglobin level postoperatively or at discharge or the number of units transfused (OR?=?1.18, 95% CI?=?1.09 to 1.28, p?<?0.001). CONCLUSION: Transfusion of allogeneic blood is independently associated with increased hospital stay after total hip arthroplasty. Blood management modalities that can significantly reduce transfusion risk could impact length of stay as well as the total cost of hip replacement procedures.
| S-EPMC4071463 | biostudies-other
Project description:The objective of this study was to assess the number and magnitude of preoperative expectations and to correlate them with the degree of satisfaction expressed one year after Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA), in patients with severe and painful osteoarthritis (OA).Preoperative expectations (within 20 days prior to surgery) and postoperative satisfaction (one year after the intervention) were measured using the previously validated French version of the Hospital for Special Surgery Hip or Knee Replacement Expectations Survey. Postoperative satisfaction was measured using a specific scale, following the same methodology as that used for the assessment of expectations. Prediction of the satisfaction of the patients was performed using multivariate linear regression modelling.A total of 138 patients (80 THA and 58 TKA) completed the two parts of the study. The expectations score (mean ± SD) (range 0-100) was 72.58 ± 12.63 before THA and 69.10 ± 13.72 before TKA (p = 0.13). The number of expectations expressed was 14.34 ± 1.32 (out of a potential maximum of 18) before THA and 14.70 ± 2.29 (out of a potential maximum of 19) before TKA. After 1 year, THA generated a significantly higher degree of satisfaction compared to TKA (69.70 ± 14.46 v 60.44 ± 17.54, p<0.001) (range 0-100). The pre-operative expectations score was the single best positive predictor of the post-surgery satisfaction assessment both for TKA and THA.Patients undergoing total joint arthroplasty for end-stage OA have a high level of expectations, before both THA and TKA. While both types of interventions significantly improve essential and non-essential activities, the rate of satisfaction is significantly greater post THA. Preoperative expectations are a major contributor to the final degree of satisfaction, one year after surgery. These results re-emphasize the need for an optimal preoperative interaction between health care providers and patients, to allow patients a chance to foresee a reasonable outcome after TJA.
| S-EPMC5158008 | biostudies-literature
Project description:BACKGROUND: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). METHODS: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 (12 preoperative variables, 1 intraoperative variable, and 3 postoperative variables) were investigated. The patients requiring a hospital stay longer than the mean LOS (8?days) were defined as patients with a prolonged LOS. The factors with a P value less than 0.1 in the univariate analysis were further analysed in a multivariate model. An ordinal regression was used to determine independent risk factors for a prolonged LOS. RESULTS:The mean LOS was 8.3?days (±4.3), with a range of 2 to 30?days. Sixteen variables were analysed by univariate analysis, and 11 of them had p?<?0.1 and were included in the multivariable model. Finally, 9 factors were found to be associated with a prolonged LOS. Among the 9 variables, 2 were surgery-related factors (operative time and intraoperative blood loss), and 3 were patient-related factors (age, ASA classification and neurological comorbidities). CONCLUSION:In this study, we found that the clinical protocol, complications, the patient's age, the ASA classification, neurological comorbidities, the operative time, the ward, intraoperative blood loss and the surgeon were all factors contributing to a prolonged LOS. In clinical practice, these factors provide important information for the surgeon and are useful for identifying patients with a high risk of a prolonged LOS.
| S-EPMC6995082 | 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: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 SARS-CoV-2 (COVID-19) pandemic caused a massive disruption in elective arthroplasty practice in the United States that to date has not been quantified. We sought to determine the impact of COVID-19 on arthroplasty volumes in the United States, how this varied across the country, and the resultant financial implications.MethodsWe conducted a retrospective analysis of Medicare fee-for-service beneficiaries undergoing primary and revision total knee arthroplasty (TKA) and total hip arthroplasty (THA) from January 1st through March 31st, 2020 with 74,080 TKAs and 54,975 THAs identified. We calculated the percent drop in average daily cases from before and after March 18, 2020. We then examined variation across states in arthroplasty case volumes as it related to reported COVID-19 cases, the impact of COVID-19 on length of stay and percentage of patients discharged home. Finally, we calculated the revenue impact on hospitals and surgeons.ResultsThere was a steep decline in TKA and THA volumes in mid-March of 94% and 92%, respectively. There was a significant variation for arthroplasty case volumes across states. We found minimal change in length of stay except for primary THAs with fracture going from 5 + days to 4 days. We saw an increasing trend in discharge to home with the greatest effect in primary THAs with fracture. The total daily hospital Medicare revenue for arthroplasty declined by 87% and surgeon revenue decreased by 85%.ConclusionThe beginning of the COVID-19 pandemic caused a significant decrease in arthroplasty volumes in the Medicare population with a resultant substantial revenue loss for hospitals and surgeons.
| S-EPMC7837224 | biostudies-literature
Project description:BackgroundLeg-length discrepancy (LLD) after primary THA is not uncommon. Little is known, however, about the role of hip-sparing procedures for equalization of LLD after THA.Questions/purposesThe aim of this study is to report our experiences with these techniques in patients presenting at one institution over a 10-year period.MethodsWe retrospectively reviewed records at one institution to find patients who had sought surgical treatment for LLD after THA between January 2007 and August 2017. Patients who had LLD related to conditions other than the THA, such as bone loss or traumatic defects, were excluded. We recorded the time after THA, laterality, and LLD. Assessment of LLD was performed using clinical and radiographic examinations. Patient demographics and true LLD were recorded, as were prior conservative treatment, equalization procedure performed, final leg length after equalization surgery, time to healing, and complications.ResultsAfter exclusion of patients with LLD related to other causes, eight patients in whom conservative treatment had failed and who had undergone hip-sparing leg-length equalization surgery were included in the study. The average age was 44.6 years (range, 18 to 66 years). Seven of the patients were female. The pre-operative mean LLD was 3.1 cm (range 1.5 to 7 cm). In those who were long after THA, ipsilateral (THA-side) shortening of femur with a retrograde intramedullary nail (IMN; n = 1) or with a plate (n = 1) was performed. In those who were short after THA, ipsilateral femur lengthening with retrograde Precice nails (n = 2), ipsilateral tibial lengthening with Precice nails (n = 2), or contralateral femur shortening with a retrograde IMN (n = 2) was performed. The average time to full consolidation or union was 6.6 months (range, 2 to 19 months). Two patients had delayed union. All patients but one were satisfied with final results.ConclusionWe believe that hip-sparing equalization procedures can be part of the treatment algorithm of LLD after THA. These advancements in the field are promising and might expand the indications of lengthening and equalization procedures to include LLD after THA.
| S-EPMC7749886 | biostudies-literature
Project description:Background:As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients. Methods:A retrospective analysis of patients undergoing elective primary or revision THA was conducted at a single institution. Multivariable regressions were utilized to assess the significant predictive factors for lengths of stay, total costs, and discharge to skilled nursing facilities (SNFs), rehabilitation centers, and home. Controls included demographic factors, insurance coverage, and the type of procedure. Results:ASA scores ?3 are the only significant predictors of discharge to SNFs (odds ratio [OR] = 1.69, confidence interval [CI] = 1.04-2.74) and home (OR = 0.57, CI = 0.34-0.98). Medicaid coverage (OR = 2.61, CI = 1.37-4.96) and African-American race (OR = 2.60, CI = 1.59-4.25) were additional significant predictors of discharge to SNF. SOI scores are the only significant predictors of length of stay (? = 1.36 days, CI = 0.53-2.19) and total cost for an episode (? = $6,234, CI = $3577-$8891). MP scores possess limited predictive power over lengths of stay only. Conclusions:These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.
| S-EPMC5994639 | 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