The Evaluation of Comorbidities Relative to Length of Stay for Total Joint Arthroplasty Patients

Sikora‐Klak, Jakub; Gupta, Andrew; Bergum, Christopher; Zarling, Bradley J.; Markel, David C.

doi:10.1016/j.arth.2016.10.034

Cited by 24 publications

(14 citation statements)

References 25 publications

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“…We found that female gender was 2.62 times more likely to have LOS > 3, which is in accordance with previous findings showing that females had a higher chance of increased hospital stay. Studies attributed this to be due to the later stage of disease and worse functional status female patients had before surgery.…”

Section: Discussionsupporting

confidence: 92%

“…With regard to the influence of BMI on LOS, there was conflicting evidence in the literature. Some studies reported a positive correlation between BMI and LOS while others suggested no association between higher BMI and longer LOS. Maradit Kremers et al .…”

Section: Discussionmentioning

confidence: 99%

“…L OS after primary THA was reported to generally decline in the ERAS program without associated rise in complication and readmission rates [4][5][6][7][8][9]14 . Identifying predictors of prolonged LOS in ERAS programs helps to optimize patient selection, predict risk stratification, improve perioperative management, and improve patients' satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Identifying predictors of prolonged LOS in ERAS programs helps to optimize patient selection, predict risk stratification, improve perioperative management, and improve patients' satisfaction. Recent studies have reported multiple risk predictors for prolonged LOS, which were defined as over 1-4 days hospital stay in different studies [4][5][6][7][8][9]14 . However, few previous studies reported preoperative and perioperative predictors of LOS after THA in a Chinese population.…”

Section: Discussionmentioning

confidence: 99%

“…The ERAS program has recently gained special attention in THA procedure 3 . In the ERAS program, hospital length of stay (LOS) after THA was reported to generally decline [4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

Ding

Liang

et al. 2019

Orthopaedic Surgery

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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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Ding

Liang

et al. 2019

Orthopaedic Surgery

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A retrospective analysis of the use of intravenous dexamethasone for postoperative nausea and vomiting in total joint replacement

2019

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Background Multimodal perioperative pain-management protocols have contributed to the success of elective total joint replacement in orthopedic surgery. General or neuraxial anesthesia for arthroplasty is accompanied by complications such as pruritis, nausea, and vomiting. Dexamethasone has been demonstrated to be a safe perioperative antiemetic. This study evaluates the benefit of low-dose intravenous dexamethasone used in the perioperative period to prevent postoperative nausea and vomiting. Methods Two scheduled doses of 8 mg of dexamethasone 12 hours apart after total hip arthroplasty or total knee arthroplasty were given to a dexamethasone group (n = 492) and were retrospectively compared with a no-dexamethasone group (n = 364) based on the use of antiemetics in the postoperative period. Frequency of antiemetic use in both groups was compared using a zero-inflated fixed-model Poisson distribution. Additional analysis included need for opioid analgesic, administration of diphenhydramine, and postoperative infection rates at 30 and 90 days. Results The dexamethasone group was found to have a significant reduction in need for the rescue antiemetic ondansetron ( P = .00194). There was an associated reduction in length of stay for the treatment group (mean 1.83 days) relative to the control group (mean 2.17 days) ( P < .001). There was no significant difference in postoperative infection rates at 30 or 90 days after arthroplasty. Conclusions Dexamethasone is a safe adjunct to perioperative protocol that may reduce nausea, thus improving patient satisfaction. There is an associated reduction in length of stay that may reduce cost of hospitalization.

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Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

et al. 2021

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Background: Laboratory studies are routinely obtained preoperatively and postoperatively for total hip arthroplasty (THA) and total knee arthroplasty (TKA). This study evaluates the necessity of routine, perioperative laboratory tests and identifies risk factors for laboratory-associated interventions. Methods: This retrospective review evaluated 967 consecutive patients scheduled for primary, unilateral TKAs (n ¼ 593) or THAs (n ¼ 374) over an 18-month period at a single institution. Preoperative prothrombin time (PT) and International Normalized Ratio (INR), complete blood count (CBC), complete metabolic panel (CMP), and postoperative CBC and basic metabolic panel (BMP) were recorded along with any laboratory-associated intervention. Patient demographics and comorbidities identified risk factors for abnormal or actionable laboratory studies. Results: Preoperatively, the actionable rates for PT/INR, CMP, and CBC were 0.3%, 1.4%, and 0.5%, respectively. Vascular, renal, and immunologic diseases were risk factors for an actionable CBC. Risk factors for an actionable CMP include cardiac arrhythmia and diabetes. There were no risk factors for an actionable PT/INR. Postoperatively, only 1.5% of BMPs and 1.5% of CBCs were actionable. Congestive heart failure, renal disease vascular disease, or history of cancer (P ¼ .030) were risk factors for an actionable CBC. There were no risk factors for an actionable BMP. Patients with an abnormal preoperative lab were 2.4 times more likely to have an actionable postoperative lab. Patients with an actionable preoperative lab were 11.3 times more likely to have an actionable postoperative lab. Conclusion: Routine preoperative and postoperative labs may not be necessary on all patients undergoing a TKA or THA. Comorbid risk factors and abnormal or actionable preoperative CMPs and CBCs can help determine the usefulness of postoperative laboratory assessments.

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The Evaluation of Comorbidities Relative to Length of Stay for Total Joint Arthroplasty Patients

Cited by 24 publications

References 25 publications

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

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

A retrospective analysis of the use of intravenous dexamethasone for postoperative nausea and vomiting in total joint replacement

Usefulness of Perioperative Laboratory Tests in Total Hip and Knee Arthroplasty: Are They Necessary for All Patients?

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