Limited Influence of Comorbidities on Length of Stay after Total Hip Arthroplasty: Experience of Enhanced Recovery after Surgery

Abstract

Objectives To identify predictors of length of stay (LOS) after total hip arthroplasty (THA) in an enhanced recovery after surgery (ERAS) program and evaluate the safety and cost‐efficiency of the ERAS program with reduced LOS for unselected patients in a Chinese population. Methods A total of 311 consecutive, unselected patients undergoing primary THA at a single institution were retrospectively reviewed and divided into two groups: LOS ≤ 3 and LOS > 3 group. All patients were managed with the same ERAS protocol and went back home after discharge. Multivariate logistic regression analysis was used to determine independent risk factors for LOS > 3. Harris Hip Score at 90‐day follow‐up, 90‐day readmission rate, and hospitalization costs were compared between two groups. Results Multivariate regression analysis identified female gender (odds ratio [OR] = 2.623), living alone (OR = 4.127), and primary osteoarthritis of hip (OR = 3.565) to be correlated with LOS > 3. Preoperative hemoglobin (HB), postoperative HB, drain use, blood transfusion, diabetes, respiratory disease, osteoporosis, number of comorbidities, and CCI score showed no significant influence on LOS after adjusting for other risk factors in the multivariate model. Harris Hip Score and readmission rate at 90‐day follow‐up showed no significant differences between two groups. Patients in LOS > 3 group had approximately 3948.6 Chinese yuan higher hospital costs. Conclusion Female gender, living alone, and primary osteoarthritis of hip were identified as independent risk factors for prolonged LOS. The experience from our institution suggested aggressive management of comorbidities in the ERAS program can minimize the influence of comorbidities on LOS. The safety, efficiency, and costs‐saving benefits of the ERAS program with reduced LOS for unselected patients was confirmed in this study.

Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): a randomized double blinded clinical trial

“…These pathologies, as shown by some studies, can interfere with the rehabilitation of the patient, increasing the length of hospital stay 49,50 . However, this is not unanimous in the literature, as other studies have not found this relationship 51 . Therefore, we believe that despite being a limitation of our study, it may not have a great impact since all patients undergo a clinical evaluation prior to surgery, as well as a careful pre-anesthetic evaluation, which means that the patients are clinically stable and have their pathologies adjusted.…”

Does well‐controlled overt hypothyroidism increase the risk of total knee arthroplasty?

“…15 Thromboprophylaxis was started in a timely manner: a half dose of low-molecular weight heparin (0.2 mL 2000 IU) was given to patients 6 h postoperatively, and a full dose (0.4 mL 4000 IU) was given at 24 h intervals in the subsequent days by subcutaneous injection till the day of discharge. 16 The criterion of blood transfusion was set as haemoglobin (Hb) level of <70 or 70~100 g/L but with symptomatic anaemia (defined as severe mental status changes, palpitations and/or pallor).…”

Minimum 8-year follow-up of revision THA with severe femoral bone defects using extensively porous-coated stems and cortical strut allografts

“…All patients were encouraged to conduct isometric exercises and active motions while in bed immediately after surgery. All patients were treated with antibiotic prophylaxis and deep venous thromboembolism prophylaxis postoperatively [14]. Generally, the patients were mobilized with partial weight-bearing at 1 to 4 weeks after surgery depending on the degree of bone defect.…”