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

Halawi, Mohamad J.; Vovos, Tyler J.; Green, Cindy L.; Wellman, Samuel S.; Attarian, David E.; Bolognesi, Michael P.

doi:10.1016/j.arth.2014.10.033

Cited by 22 publications

(13 citation statements)

References 23 publications

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“…Halawi et al [ 17 ] retrospectively reviewed 112 consecutive patients who underwent total hip arthroplasty and found a significant association between PLOS and preoperative pain level. In this study, we analyzed the relationship between VAS pain score preoperatively and on POD1, POD3, and PLOS of TKA.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

et al. 2018

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BackgroundHospital length of stay (LOS) after primary total knee arthroplasty (TKA) has decreased obviously following the implementation of enhanced recovery after surgery (ERAS) program in the last few years. However, there are still some patients that cannot be discharged at early time for a variety of reasons, and it is necessary to explore factors leading to prolonged LOS. Therefore, the purpose of this study was to identify the complete preoperative, perioperative, and postoperative factors associated with prolonged postoperative LOS (PLOS) after primary TKA in a detailed ERAS program.MethodsIn a consecutive series from July 2015 to March 2017, all patients who underwent unilateral elective primary TKA were included in the retrospective study. A PLOS greater than 3 days was considered a prolonged PLOS. Multivariable logistic regression analysis was performed to identify patient characteristics and relevant preoperative, perioperative, and postoperative variables that were associated with prolonged PLOS and postoperative complications.ResultsA total of 241 patients were included with a mean PLOS of 3.8 days. Prolonged PLOS was significantly associated with preoperative valgus deformity of the knee (OR 4.95, 95%CI 1.56–15.77, P = 0.007), increased serum level of interleukin-6 on postoperative day 1 (OR 1.01, 95%CI 1.00–1.03, P = 0.039), increased visual analogue scale pain score and serum level of C-reactive protein on postoperative day 3 (OR 2.56, 95%CI 1.28–5.13, P = 0.008; OR 1.01, 95%CI 1.00–1.03, P = 0.019), increased day to achieve 90° active knee flexion after surgery (OR 2.19, 95%CI 1.27–3.79, P = 0.005), and postoperative wound complications (OR 8.58, 95%CI 2.10–35.03, P = 0.003) and other minor complications (OR 6.04, 95%CI 2.40–15.19, P < 0.001). Preoperative pulmonary infection (OR 2.75, 95%CI 1.20–6.28, P = 0.016), American Society of Anesthesiologists score 3/4 (OR 2.14, 95%CI 1.01–4.52, P = 0.046), and utilization of catheter after surgery (OR 2.53, 95%CI 1.23–5.19, P = 0.012) were significantly associated with postoperative complications.ConclusionsMultiple factors were associated with prolonged PLOS and postoperative complications after TKA in the ERAS program. It is important to recognize all the factors to try to maximize the use of medical resources and ultimately optimize the care of our patients.

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Section: Discussionmentioning

confidence: 99%

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

et al. 2018

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“…Although we anticipated seeing a reduction in LOS, we had expected the decrease to be more clinically meaningful. Other studies have shown that multiple factors may affect LOS, including patient expectations and care pathways [23], [24], [25]. Although our group took a significant effort into modifying the simple to make changes, such as PT staffing hours, we have lacked needed resources and institutional support to similarly improve the other components.…”

Section: Discussionmentioning

confidence: 99%

Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing

et al. 2017

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BackgroundAn early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours.MethodsAfter receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed.ResultsEarly evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change (P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change (P = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 (P = .038) and had longer hospital stays (P < .001). Early mobilization in the entire cohort was associated with a greater cost savings (P < .001).ConclusionsA relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

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“…Existing literature suggests an association between expectation fulfillment and patient satisfaction. 5,[8][9][10][11][12][13][14][15][16][17][18] Further investigation is needed to determine whether setting realistic expectations prior to MMS can improve patient satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…7 Numerous studies from other surgical specialties have shown that patients are dissatisfied when their expectations do not match the actual outcome. 5,[8][9][10][11][12][13][14][15][16][17][18] Few studies have examined patient expectations for scarring after skin cancer surgery. 5 The primary objective of this study was to compare patients' and surgeons' preoperative estimations of scar length with actual scar length after MMS for facial skin cancers.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers

et al. 2020

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IMPORTANCE Patients are satisfied when surgical outcomes meet their expectations. Dissatisfaction with surgical scars is one of the most common reasons that patients sue surgeons who perform Mohs micrographic surgery (MMS). OBJECTIVE To measure the accuracy of patient and physician estimations of scar length prior to skin cancer removal with MMS. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted between December 1, 2017, and February 28, 2018, at the MMS clinic of a single tertiary referral center health system. A total of 101 adults presenting for MMS for treatment of facial skin cancers volunteered for this study, and 86 surgeons who performed the MMS procedure participated. MAIN OUTCOMES AND MEASURES Patients and physicians independently drew the anticipated scar length on the patients' skin prior to surgery. Preoperative estimates by patients and surgeons were compared with actual postoperative scar length. RESULTS Of the 101 patients who participated, 57 patients (56.4%) were men and 57 patients (56.4%) were aged 65 years or older. Eighty-four patients (83.2%) underestimated scar length, whereas 67 of the 86 surgeons (77.9%) correctly estimated the scar length (P < .001). The actual postoperative scar length was 2.2 (interquartile range, 1.5-3.6) times larger than the patients' preoperative estimate but only 1.1 (interquartile range, 1.0-1.2) times larger than the surgeons' preoperative estimate (P < .001). Preoperative consultation with the surgeon, a personal history of MMS, or patient-directed research about MMS were not associated with improvement of patients' estimations of scar length. CONCLUSIONS AND RELEVANCE This study's findings suggest that patients with facial skin cancers have unrealistic expectations regarding scars that measure, on average, less than half the length of the actual postoperative scars. Surgeons appear to accurately estimate the length of most surgical scars and have an opportunity to set realistic patient expectations about scar length before surgery.

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

Cited by 22 publications

References 23 publications

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

Factors influencing postoperative length of stay in an enhanced recovery after surgery program for primary total knee arthroplasty

Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing

Comparison of Accuracy of Patient and Physician Scar Length Estimates Before Mohs Micrographic Surgery for Facial Skin Cancers

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