Factors Independently Associated With Complications and Length of Stay after Hip Arthroplasty

O’Malley, Natasha T.; Fleming, Fergal J.; Gunzler, Douglas D.; Messing, Susan; Kates, Stephen L.

doi:10.1016/j.arth.2012.04.025

Cited by 80 publications

(58 citation statements)

References 36 publications

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“…Patient expectation of discharge to ECF remained a significant predictor of increased LOS even after controlling for Medicare's 3-day rule to quality for discharge to ECF. We have also confirmed earlier findings, particularly the association between LOS and age [9][10][11][12] and absence of association between LOS and BMI, sex, and comorbidities [10,13,16]. Pain and patient expectations represent compelling targets for intervention to reduce LOS.…”

Section: Discussionsupporting

confidence: 89%

“…Previous studies have identified several factors that influence LOS after primary THA, including age [9][10][11][12], sex [9,10,12], comorbidities [12,13], body mass index [14], surgical approach [15], use of assistive devices [16], functional status [12], general health perception [10,13], and surgeon experience [10]. However, many of those studies had significantly long mean LOS [9,10], excluded patients with diagnoses other than primary osteoarthritis [16], focused only on select comorbidities [12], or required the use of time-consuming scoring systems [10,13].…”

mentioning

confidence: 99%

“…However, many of those studies had significantly long mean LOS [9,10], excluded patients with diagnoses other than primary osteoarthritis [16], focused only on select comorbidities [12], or required the use of time-consuming scoring systems [10,13]. Furthermore, previous studies often had postoperative rehabilitation protocols geared toward discharge to home [16], which has limited application to current practice where patients with slow postoperative recovery can be discharged to ECF.…”

mentioning

confidence: 99%

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Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Halawi

Vovos

Green

et al. 2015

The Journal of Arthroplasty

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a b s t r a c t a r t i c l e i n f oThe purpose of this study was to identify preoperative predictors of length of stay after primary total hip arthroplasty in a patient population reflecting current trends toward shorter hospitalization and using readily obtainable factors that do not require scoring systems. A retrospective review of 112 consecutive patients was performed. High preoperative pain level and patient expectation of discharge to extended care facilities (ECFs) were the only significant multivariable predictors of hospitalization extending beyond 2 days (P = 0.001 and P b 0.001 respectively). Patient expectation remained significant after adjusting for Medicare's 3-day requirement for discharge to ECFs (P b 0.001). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a concordance index of 0.857.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Halawi

Vovos

Green

et al. 2015

The Journal of Arthroplasty

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“…Our data do not suggest that either system is performing more accurately than the other; however, that the NSQIP requires these specific criteria to be documented in the medical record likely explains why the frequencies documented in the NSQIP are lower than those in the NIS. Some recent studies may be affected by these findings [10,11,14,16,19].…”

Section: Discussionmentioning

confidence: 93%

“…For example, recent studies using the NIS have investigated the effects of comorbidities on hospitalization costs after hip fracture [13], risk factors for elderly patients undergoing total joint arthroplasty [5], and perioperative morbidity and mortality after bilateral THAs [17]. Similarly, recent studies using the NSQIP have investigated risk factors for morbidity and mortality after knee arthroscopy [11], risk for morbidity and mortality after hip fracture surgery [16], and factors independently associated with complications and length of stay after hip arthroplasty [14].…”

Section: Introductionmentioning

confidence: 99%

Nationwide Inpatient Sample and National Surgical Quality Improvement Program Give Different Results in Hip Fracture Studies

Bohl

Basques

Golinvaux

et al. 2014

Clinical Orthopaedics &Amp; Related Research

179

123

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Background National databases are being used with increasing frequency to conduct orthopaedic research. However, there are important differences in these databases, which could result in different answers to similar questions; this important potential limitation pertaining to database research in orthopaedic surgery has not been adequately explored. Questions/purposes The purpose of this study was to explore the interdatabase reliability of two commonly used national databases, the Nationwide Inpatient Sample (NIS) and the National Surgical Quality Improvement Program (NSQIP), in terms of (1) demographics; (2) comorbidities; and (3) adverse events. In addition, using the NSQIP database, we identified (4) adverse events that had a higher prevalence after rather than before discharge, which has important implications for interpretation of studies conducted in the NIS. Methods A retrospective cohort study of patients undergoing operative stabilization of transcervical and intertrochanteric hip fractures during 2009 to 2011 was performed in the NIS and NSQIP. Totals of 122,712 and 5021 patients were included from the NIS and NSQIP, respectively. Age, sex, fracture type, and lengths of stay were compared. Comorbidities common to both databases were compared in terms of more or less than twofold difference between the two databases. Similar comparisons were made for adverse events. Finally, adverse events that had a greater postdischarge prevalence were identified from the NSQIP database. Tests for statistical difference were thought to be of little value given the large sample size and the resulting fact that statistical differences would have been identified even for small, clinically inconsequential differences resulting from the associated high power. Because it is of greater clinical importance to focus on the magnitude of differences, the databases were compared by absolute differences. Results Demographics and hospital lengths of stay were not different between the two databases. In terms of comorbidities, the prevalences of nonmorbid obesity, coagulopathy, and anemia in found in the NSQIP were more than twice those in the NIS; the prevalence of peripheral vascular disease in the NIS was more than twice that in the NSQIP. Four other comorbidities had prevalences that were not different between the two databases. In terms of inpatient adverse events, the frequencies of acute kidney injury and urinary tract infection in the NIS were more than twice those in the NSQIP. Ten other inpatient adverse events had frequencies that were not different between the two databases. Because it does not collect data after patient discharge, it can be implied from the NSQIP data that the NIS does not capture more than 1 .

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Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

et al. 2020

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Background: Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has demonstrated excellent safety and is receiving wider use in North America. Understanding which factors lead to operative difficulty, as evaluated by operative time (OT), may help to improve safety and refine indications for this procedure. Methods: Cases of TOETVA performed at our institution were reviewed. Multivariate linear regression was performed using patient demographics, thyroid characteristics, and operative variables to predict OT. Results: A total of 207 cases were included for analysis. A multivariate linear regression model, controlling for age, sex, and BMI, was developed from 104 cases with an R 2 of 0.47 (p < 0.001). Cross-validation on 103 remaining cases showed root-mean-square error of 46.37. Total thyroidectomy and lobe size were the only significant predictors (p < 0.001). Conclusions: We successfully developed a model to predict OT for TOETVA based on preoperative and operative variables. Lobe size, but not BMI, is a significant predictor of OT.

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Factors Independently Associated With Complications and Length of Stay after Hip Arthroplasty

Cited by 80 publications

References 36 publications

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Preoperative Pain Level and Patient Expectation Predict Hospital Length of Stay After Total Hip Arthroplasty

Nationwide Inpatient Sample and National Surgical Quality Improvement Program Give Different Results in Hip Fracture Studies

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

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