The Main Predictors of Length of Stay After Total Knee Arthroplasty

Piuzzi, Nicolás S.; Gj, Strnad; Wa, Sakr Esa; Wk, Barsoum; Mr, Bloomfield; Pj, Brooks; Ca, Higuera-Rueda; Joyce, Malcolm J.; Kattan, Michael W.; Aa, Klika; Krebs, Lone; Nw, Mesko; Ma, Mont; Tg, Murray; Gf, Muschler; Rj, Nickodem; Patel, Paresh D.; Jl, Schaffer; Kp, Spindler; Kl, Stearns; Jc, Suárez; Zajichek, Alexander; Rm, Molloy

doi:10.2106/jbjs.18.00758

Cited by 64 publications

(19 citation statements)

References 34 publications

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“…[6,10] However, to reach purpose of reducing LOS is not such simple as many patient characteristics are associated with it, like age, sex, marital status, co-morbidity and early rehabilitation. [6,11] Clinical pathway at our institution focused on early rehabilitation and we believe that this factor was the primarily responsible for reducing LOS. We showed there was a significant increase in the number of patients starting physical therapy within 24 hours of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Besides patient-related factors, as already mentioned, there are also structural-related risk factors influencing LOS. [11] Piuzzi et al [11] have reported patient-related factors such as sex, age and comorbidities are important but are not the main drivers of the LOS. Our results corroborate with their results, since the two groups did not differ regarding demographic characteristics despite difference found in the LOS.…”

Section: Plos Onementioning

confidence: 99%

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Clinical pathway improves medical practice in total knee arthroplasty

et al. 2020

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Clinical pathways in total knee arthroplasty (TKA) consist of general guidelines, including several topics as early rehabilitation and antibiotic systematization, which are used to improve patient's management, decrease complication rates and enhance clinical outcomes. The primary purpose of this study was to assess whether the use of a clinical pathway for TKA can contribute to reduce LOS and healthcare costs in a private hospital, without an increase in the hospital readmission rate. We also aimed to assess whether care providers adhered to the recommendations mainly antibiotic use and physical therapy. Methods Retrospective cohort study of 485 patients who underwent TKA at private hospital. Patients were analyzed in two groups: Group I (GI), composed by 220 TKA patients, prior to the clinical pathway implementation, and Group 2 (GII), with 265 TKA patients post-clinical pathway. Several outcomes were analyzed: length of hospital stay, time from use of prophylactic antibiotic therapy, readmission within 30 days, physical therapy and costs associated to procedures and hospitalization rates. Results The implementation of the clinical pathway was related with the reduction of the length of hospital stay from 6.3 days to 4.9 days (p = 0.021) without increase in readmissions. The physical therapy on the first postoperative day was most frequent in GII than GI (96.2% vs 78.1%, p < 0.001). Prophylactic ATB 60 minutes prior the surgery was significantly more used in GII than GI (99.2% vs 87.4%, p < 0.001). In addition, ATB suspension within 48 hours was significantly more frequent in GII than GI (84.7% vs. 51.6%, p < 0.001). The cost procedure of TKA showed a reduction of US$1,252.00 in GII when compared with GI (p<0,001).

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Section: Discussionmentioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Clinical pathway improves medical practice in total knee arthroplasty

et al. 2020

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“…In comparison, obesity and high BMI may increase LOS after TKA (Piuzzi et al. 2019 , Shah et al. 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty

et al. 2021

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Background and purpose — The indications for unicompartmental knee arthroplasty (UKA) have become less restrictive and, today, high age and high BMI are not considered contraindications by many surgeons. While the influence of these patient characteristics on total knee arthroplasty is well documented, evidence on UKA is lacking. We investigated the effect of BMI and age on day of surgery (DOS) discharge, prolonged admission, and 90-day readmission following UKA surgery. Patients and methods — This retrospective cohort study included 3,897 UKA patients operated on between 2010 and 2018 in 8 fast-track arthroplasty centers. Patients were divided into 5 BMI groups and 5 age groups. Differences between groups in the occurrence of DOS discharge, prolonged admission > 2 days, and 90-day readmission was investigated using a chi-square test and mixed-effect models adjusted for patient characteristics using surgical center as a random effect. Results — Median LOS was 1 day. DOS discharge was achieved in 26% of patients with no statistically significant differences between BMI groups. DOS discharge was less likely in UKA patients aged > 70 years (age 71–80; odds ratio [OR] 0.7 [95% CI 0.6–0.9]). Prolonged admission was not affected by BMI or age in the adjusted analysis. 90-day readmission was more likely in patients with BMI > 35 (OR 1.9 [CI 1.1–3.1]) and patients aged 71–80 (OR 1.5 [CI 1.1–2.1]). Interpretation — Age > 70 years decreased the likelihood of DOS discharge after UKA. High BMI as well as advanced age increased the likelihood of 90-day readmission. This should be noted by surgeons operating on patients with high BMI and age.

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“…The Akaike information criterion (AIC) was used to evaluate the different models. Variable importance plots were obtained by ranking each variable by the increase in AIC upon its removal [12]. AIC ≥2 represents a statistically better model [13].…”

Section: Proportional Odds Logistic Regression Modelsmentioning

confidence: 99%

Potential Value of Periostin as a Clinically Applicable Biomarker for Osteoarthritis

Tan¹,

Zhong-wei²,

Xing³

et al. 2021

Preprint

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Background: Emerging knowledge has highlighted the role of periostin (POSTN) in osteoarthritis (OA) process; however, whether POSTN is suitable as a biomarker of OA remains unclear. Herein, we investigated the potential value of POSTN as a biomarker of OA. Methods: We detected the expression of POSTN in the cartilage of ovariectomy (OVX)-OA rats and different compartments of the knee joint in patients with OA using immunohistochemistry and examined serum POSTN levels in patients with or without OA using enzyme-linked immunosorbent assay (ELISA). The associations among serum POSTN levels, clinical symptoms, and radiological severity were assessed according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and, Kellgren-Lawrence (KL) grading, respectively. Finally, multivariable cumulative link models were established to evaluate the validity of serum POSTN as a predictor of knee OA.Results: The significantly higher POSTN expression was found in OVX-OA rats than Sham rats, while, the expression of POSTN was significantly higher in the torn cartilage of patients with OA. However, the serum POSTN level did not differ significantly between patients with and without OA. Additionally, we found no remarkable associations between serum POSTN level and WOMAC scores and KL grading. Subsequent analysis revealed that serum POSTN was not a significant predictor of OA.Conclusion: Thus, although POSTN may be involved in the initiation and progression of OA and local POSTN is valuable in disease diagnosis and distinguishing of the severity of disease, its serum level is not sufficient to serve as a candidate biomarker of OA given the current analysis technology.

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The Main Predictors of Length of Stay After Total Knee Arthroplasty

Cited by 64 publications

References 34 publications

Clinical pathway improves medical practice in total knee arthroplasty

Clinical pathway improves medical practice in total knee arthroplasty

Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty

Potential Value of Periostin as a Clinically Applicable Biomarker for Osteoarthritis

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