Determining Predictors That Affect Discharge Destination From the Acute Care Setting Following Elective Total Hip Arthroplasty

Félix, Ioonna; Fritzsche, K.

doi:10.1097/00013614-200410000-00024

Cited by 2 publications

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“…In our study, gait distance and balance were used as predictors of LOS. Ability to walk and walking distance have been reported to predict discharge destination following total hip replacement [19, 50] and following LSS [51], while balance, to our knowledge, was not reported before in similar studies. Clinicians should consider better post-operative pain management approaches and increased frequency of post-operative rehabilitation as possible strategies to modify post-surgical factors and facilitate patient's functional recovery to shorten LOS.…”

Section: Discussionmentioning

confidence: 59%

Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery

et al. 2015

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Background context Length of hospital stay (LOS) after lumbar spine surgery (LSS) can be affected by many factors. However, few studies have evaluated predictors of LOS, and all have used limited number of variables as predictors. Purpose To identify pre-surgical, surgical, and post-surgical predictors of LOS following LSS. Study Design/Setting Retrospective review of consecutive patients who had LSS at the (Blinded) Hospital from October, 2008 to April, 2012. Patient Sample 593 patients who underwent LSS consisting of laminotomy, laminectomy, or arthrodesis. Outcome Measures Dependent variable: LOS. Multiple pre-surgical, surgical, and post-surgical variables were extracted from patients’ medical records and considered as possible predictors (independent variables) of LOS. Methods Potential predictors that were significantly correlated with LOS were used as indicators to construct three latent factors; pre-surgical, surgical, and post-surgical, which were in turn used to predict LOS in a structural equation model (SEM). Results The average LOS was 4.01±2.73 days. The pre-surgical factor was indicated by age (61.97±14.49 years), prior level of function (60.5% were totally independent), prior hemoglobin level (13.70±1.36 mg/dl), and use of assistive devices (60% were assistive device users). The surgical factor was indicated by severity of illness (50.2% had minor disease severity), presence of complications (1.9%), and stay in an intensive care unit (4.0%). The post-surgical factor was indicated by post-surgical walking distance (166.43±175.75 feet), level of assistance during walking (5.18±0.81 out of 7 points), balance scores (6.18 ±1.82 out of 10 points), and bed mobility and transfer dependency scores (9.81± 1.99 out of 14 points). These three latent factors explained 47% of variation in LOS. Conclusion Post-surgical factors predicted the highest variation in LOS in comparison to pre-surgical and surgical factors and should be taken into consideration for discharge planning. Post-surgical factors are related to the patient's function, modifiable with rehabilitation and can be improved to shorten LOS. Inclusion of more reliable and standardized pre-surgical variables could improve the predictability of the model.

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Section: Discussionmentioning

confidence: 59%

Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery

et al. 2015

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“…Gait distance is an important outcome measure post‐LSS, as it reflects patients' recovery and return to baseline function . Gait distance is one of the main variables used by physical therapists to determine hospital discharge status and predict the length of hospital stay following total hip replacement and LSS . Patients' ability to walk depends on many factors including pain intensity and effective pain management strategies.…”

Section: Discussionmentioning

confidence: 99%

Association between Opioid Dose, Acute Post‐operative Pain and Walking Distance Following Lumbar Spine Surgery

Aoyagi

Simpson

et al. 2019

J Clin Pharm Ther

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What is known and objective: The opioid doses on post-operative day 1 (POD1) is a major predictor of recovery in patients following lumbar spine surgery (LSS). However, the opioid doses vary widely in clinical practice. Thus, the objective of this study was to explore the associations between opioid doses on POD1, pain and function during a hospital stay in patients following LSS. Methods: This study used medical records of patients who underwent LSS between January 2007 and March 2018. The patients were divided into three groups (high, medium and low dose) according to the amount of opioid (oral morphine equivalents; OME) taken on POD1. A propensity score matching across the three groups was performed to account for main confounding factors related to the opioid dose, pain intensity and gait distance, which identified 114 matched patients in each group. The difference of pain intensity and gait distance between the groups on POD1 was analysed. Results: The OME in each group on POD1 was 168.75 ± 69.50 mg (high), 65.92 ± 13.28 mg (medium) and 16.90 ± 9.80 mg (low) (P < .0001). Pain intensity on the postoperative day 2 (POD2) and 3 (POD3) was not different between the groups (P > .05). Gait distance on POD2 and POD3 was different between the groups but did not reach the adjusted statistically significant level of 0.017: high (170.3 ± 152.77 feet) versus medium (247.57 ± 216.65 feet) dose on POD2 (P = .04); high (179.31 ± 135.722 feet) versus low (230.94 ± 145.74 feet) dose on POD3 (P = .03); and medium (196.98 ± 159.42 feet) versus low (261.00 ± 161.03 feet) dose on POD3 (P = .09). What is new and conclusion: The findings indicated that high dose opioids on POD1 did not translate into better outcomes of pain and gait in patients following LSS. In fact, patients in medium and low dose groups walked a greater distance on POD2 and POD3. Use of a functional outcome such as gait should be considered to optimize opioid dose effects.

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Determining Predictors That Affect Discharge Destination From the Acute Care Setting Following Elective Total Hip Arthroplasty

Cited by 2 publications

References 0 publications

Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery

Structural equation model analysis of the length-of-hospital stay after lumbar spine surgery

Association between Opioid Dose, Acute Post‐operative Pain and Walking Distance Following Lumbar Spine Surgery

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