Do Age and Co-morbidy, Among other Factors, affect Length of Hospital Stay following Total Knee Arthroplasty

Abstract

Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient. Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient’s reluctance to undergo TKA. A clinical pathway with standard length of stay (LOS) could justify the patient’s hesitation for TKA. The aim of this study was to determine the factors, including age and comorbidity, that affect the LOS of patients treated with TKA. Materials and Methods: This is a retrospective study of TKA patients in Surabaya Orthopedics and Traumatology Hospital from January 2011 to July 2017. Preoperative comorbidities were scored using Charlson Comorbidity Index (CCI) and physical status by ASA (American Society of Anesthesiologist), classification for age, sex, BMI, blood loss, operation time, method of anaesthesia and postoperative day of rehabilitation were recorded as factors potentially affecting LOS. The discharge criteria for the patients were ability to ambulate to the bathroom and clean operative wound with no complications. The data obtained were analysed statistically.Results: The average LOS was 5.58 days, ranging from three to eight days. There were no demographic factors that affected the patients’ LOS. BMI, ASA, CCI, and blood loss did not significantly affect LOS. Operation time was between 90-140 minutes, and spinal anaesthesia showed significant longer LOS, but within the average.Conclusion: Age and comorbidity did not affect length of stay in TKA patients.

Enhanced Selection of Candidates for Same-Day and Outpatient Total Knee Arthroplasty

“…We did not identify comorbidity measures such as ASA status or PSH anesthesia PASS-GO category to be associated with LOS. While some studies concur [21], others report ASA as a surrogate for risk with ties to LOS [14]. The PASS-GO category is likely not associated with LOS as it generally relates to modifiable risk factors that are optimized before surgery.…”