The influence of pre-operative factors on the length of in-patient stay following primary total hip replacement for osteoarthritis

Abstract

We analysed which pre-operative factors could be used to predict the length of in-patient stay following unilateral primary total hip replacement undertaken for osteoarthritis. Data were collected prospectively from 2302 patients undergoing primary total hip replacement over a nine-year period. The relationships between the various pre-operative factors and length of stay were studied separately using either Student's t-test or Pearson's correlation, and then subjected to multiple linear regression analysis. The mean length of stay was 8.1 days (median 7; 3 to 58). After adjusting for the effects of other pre-operative factors, younger age, male gender, higher combined Harris hip function and activity score, higher general health perception dimension of the Short-Form 36 score, and non-steroidal anti-inflammatory drug use were all found to be significantly associated with a reduced length of stay.

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

“…Contrary to Dall et al [10], we found a significant association between LOS and preoperative pain level. Dall et al studied pain level as measured by the SF-36 pain score; however, their mean LOS was 8.1 days and no physical therapy was provided on weekends, which make direct comparison difficult.…”

“…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.…”

“…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].…”

“…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.…”

Decreased Length of Stay After TKA Is Not Associated With Increased Readmission Rates in a National Medicare Sample

“…Some of the causes of increased postoperative LOS are modifiable while others are not. Previous studies of risk factors associated with prolonged LOS after arthroplasty describe female gender, increasing age, comorbidities, obesity, higher American Society of Anesthesiologists-Physical Status scores, longer incisions, longer operative time, the need for transfusion, and postoperative complications as being associated with increased LOS [2,3,5,7,[10][11][12].…”